Transperitoneoscopic approach

The patient is placed supine on the operating table, and generally a urinary catheter is introduced, which is removed at the end of the procedure. The surgeon stood on the patient’s right side and the assistant opposite the surgeon. Each port side is first infiltrated with bupivacaine 0.25%. First a 10 mm primary port, for 0° operative telescope, is placed at the umbilicus, under direct vision. The peritoneum cavity is insufflated with CO₂ until the intra-abdominal pressure is 10–12 mmHg. Two further 5 mm ports are introduced, in the left iliac fossa and the sovrapubic side. Tilting of the table in Trendelenburg and to the right promoted exposure of left-sided varicocele. The internal inguinal ring is identified. Using dissecting shears the peritoneum is incised over testicular vessels a few centimeters above the internal ring. The spermatic vessels are elevated from the posterior pelvic wall, coagulated with bipolar electrocautery and then divided (Figure 1).

View of transperitoneal approach: the spermatic vessels are elevated from the posterior.