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Abstract

Volume 20, Issue 2 (March 2018) 20, 189–194; 10.4103/aja.aja_45_17

A retrospective review of single-institution outcomes with robotic-assisted microsurgical varicocelectomy

Andrew McCullough1, Leon Elebyjian2, Joseph Ellen3, Clay Mechlin4

1 Institute of Urology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
2 Division of Urology, Albany Medical College, Albany, NY 12208, USA
3 Virginia Urology, Richmond, VA 23230, USA
4 Urology Associates of Central Missouri, Columbia, MO 65201, USA

Correspondence: Dr. A McCullough (andrew.mccullough@lahey.org)

Date of Submission 09-Feb-2017 Date of Acceptance 14-Aug-2017 Date of Web Publication 27-Oct-2017

Abstract

We report the largest single-center experience with robotic-assisted microscopic varicocelectomy (RAMV) in male infertility. From August 2012 to February 2015, men with infertility of at least a year and varicoceles underwent RAMV by a single surgeon. Varicocele was diagnosed on physical examination and confirmed by ultrasound by a single ultrasonographer. Preoperative hormone panel, semen analyses, and testicular Doppler ultrasound were obtained from all men and repeated at 3 months. One hundred and forty consecutive men (258 varicocelectomies) were included. Mean age and duration of infertility was 36.4 and 2.8 years, respectively. Median total and free testosterone increased by 145 ng dl−1 and 4.3 pcg ml−1 (44.3%), respectively (P < 0.0001). Median sperm concentration increased by 37.3% (P < 0.03). Median sperm motility and morphology did not significantly change. Median left and right testicular volume increased by 22.3% (P < 0.0001) and 12.6% (P < 0.0006), respectively. Hydroceles occurred 0.8% of procedures. We had no testicular artery injuries. Persistence of varicocele by Doppler ultrasound was 9.6%. Only 37.3% of patients required pain medications postoperatively. We concluded that RAMV is a safe and effective alternative for varicocele repair with outcomes comparable to historical traditional microsurgical approach.

Keywords: male infertility; reproductive technology; robot-assisted microsurgery; varicocele; varicocelectomy

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