What Are the Types of Varicocelectomy?

Here are some types of varicocelectomy that your doctor may recommend:

Open Surgery

In open varicocele surgery, your surgeon makes a 2–3 cm incision in the groin area to locate and ligate the enlarged testicular veins.

Minimally Invasive Surgery

During minimally invasive surgery, your surgeon uses techniques that cause less damage to the skin and tissues. Minimally invasive varicocelectomy procedures include:

Laparoscopic Varicocelectomy

In this procedure, the inside of the abdomen is viewed using a camera with light. The main goal is to identify and ligate the affected veins to restore proper blood flow to the scrotum without damaging critical structures such as arteries and the vas deferens.

Microsurgical Varicocelectomy

Unlike open laparoscopy, this surgery is performed through a smaller incision and involves the use of a microscope. This reduces the risk of complications and improves recovery time.

Varicocele Embolization

Varicocele embolization is a percutaneous treatment performed by cardiovascular or interventional radiology specialists. The goal is to access the enlarged testicular veins from inside the body, stop blood flow, and reduce pressure. This causes the veins to shrink, reduces pain, and may improve sperm quality. However, the recurrence rate is higher compared to surgery.

What Is Microsurgical Varicocelectomy and How Is It Different?

Microsurgical varicocelectomy is a specialized surgical technique used to remove overly dilated and twisted veins (varicocele) around the testicle.

The surgeon makes a small incision near the groin and uses a microscope that magnifies veins 15–20 times to clearly distinguish which veins should be tied off and which arteries and spermatic ducts should be preserved. This ensures that blood is rerouted from problematic veins to healthy ones, maintaining testicular blood flow, preserving the spermatic tract, and protecting lymphatic channels.

This meticulous microsurgical technique “targets” the problematic veins, achieving a high success rate and significantly reducing the risk of pain and infertility.

What Are the Techniques of Microsurgical Varicocelectomy?

There are two microsurgical varicocelectomy approaches based on the incision site:

Inguinal Microsurgical Varicocelectomy: This surgery involves a 3–5 cm incision along the groin (right or left), allowing the surgeon to access the spermatic cord, which contains nerves, arteries, and veins supporting the testicles. Once identified, the cord is pulled outside the body, and the surgeon separates the structures within, identifying and isolating abnormal veins. These veins are either cauterized or closed using stitches or clips.

Subinguinal Microsurgical Varicocelectomy: The subinguinal approach involves a lower incision closer to the scrotum than the inguinal approach. This procedure takes longer because the incision is made in the groin area where the spermatic vein branches into several smaller veins. It offers the surgeon more opportunities to identify various veins and lymphatic channels.

Who Are the Best Candidates for Microsurgical Varicocelectomy?

Microsurgical varicocelectomy is most suitable for men with varicoceles visible or palpable during a physical exam. It is also effective for those experiencing pain due to varicocele, testicular shrinkage (atrophy), or abnormal semen test results.

What Is the Recovery Process After Microsurgical Varicocelectomy?

There will be some pain at the incision site due to stitches. Patients recovering from inguinal microsurgical varicocelectomy may feel more pain since the incision involves the abdominal muscles.

Full recovery is expected within two weeks. Returning to work and light activities usually takes 2 days. However, activities should be as light as possible to allow the incision to heal. Patients should avoid sexual activity for at least one to two weeks.

When Will the Results of Microsurgical Varicocelectomy Be Seen?

This surgery has an 80% success rate in improving sperm count and function. It is similarly effective in relieving pain symptoms.

What Are the Risks and Complications of Varicocelectomy?

As with many surgeries, there are potential risks and complications associated with varicocelectomy procedures. Although rare, serious complications include:

• Bleeding
• Infection
• Blood clots in the leg
• Injury or damage to the testicle
• Testicular shrinkage
• Chronic pain
• The procedure also carries risks associated with the use of anesthesia.

While the goal of varicocelectomy procedures is to eliminate varicoceles, there is a chance they may recur. It is estimated that 15% of men experience recurrence after surgery.

Studies show that around 60% of men see improved semen quality after this procedure. However, varicocelectomy does not guarantee the treatment of male infertility.

When Should You See a Doctor?

You should contact your doctor if you experience any of the following complications after varicocelectomy:

• Signs of infection near the incision site
• High fever
• Persistent swelling or pain
• Pain or swelling in the legs
• Ongoing nausea and vomiting