The aim of this study was to compare the intraoperative difference in anatomic details between loupe-assisted and microscopic
varicocelectomy within the same spermatic cord. Between April 2011 and August 2011, 26 men with 33 sides containing grade
2–3 varicocele were enrolled in this study. First, one surgeon performed the open inguinal varicocelectomy under × 3.5 loupe magnifi cation.
The presumed vascular channels and lymphatics were isolated and marked without ligation. Another surgeon then microsurgically
dissected and checked the same spermatic cord using an operating microscope to judge the results in terms of the ligation of the internal
spermatic veins and the preservation of the arteries and lymphatics. There were signifi cant differences in the average number of internal
spermatic arteries (1.51 vs 0.97), internal spermatic veins (5.70 vs 4.39) and lymphatics (3.52 vs 1.61) between the microscope and
loupe-assisted procedures (P < 0.001, P < 0.001, P < 0.001, respectively). Meanwhile, in varicocele repair with loupe magnifi cation,
an average of 1.30 ± 1.07 (43/33) internal spermatic veins per side were missed, among the overlooked veins, 1.12 ± 0.93 (37/33)
were adhered to the preserved testicular artery, as well as 0.55 ± 0.79 lymphatics and 0.36 ± 0.55 arteries that were to be ligated. In
conclusion, microscopic varicocelectomy could preserve more internal spermatic arteries and lymphatics and could ligate more veins
than the loupe-assisted procedure. To some degree, loupe magnifi cation is inadequate for the reliable identifi cation and dissection of
the tiny vessels of the spermatic cord, as most of the overlooked veins were adhered to the preserved testicular artery.

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