What we call the gold standard for fixing a varicocele is the microscopic sub-inguinal varicocelectomy. Sub-inguinal refers to the location of the incision. This single incisionis about one inch above the top of the penis and one inch to either side. If both sides are being operated on, two incisions are made. The scars will later be covered by pubic hair. This is where the spermatic cord (the bundle carrying the vas deferens, the testicular arteries, the veins, the lymphatics, and the muscles) leaves the abdominal wall. What’s important about making the incision here is that the abdominal muscle can be avoided and that means much less postoperative discomfort and significantly reduced healing time.

Microscopic means that an operating microscope is used. This large microscope stands above the patient, and the doctor performs the delicate part of the operation while looking through it. This allows the surgeon to clearly see all the veins that need to be severed, as well as the arteries and the lymphatics, which drain fluid from the space between the testes and the surrounding sac, to be avoided and not severed.

In this approach, a patient is usually sedated (asleep, but not intubated – this is safer for the patient). While sleeping, a local anesthetic is injected into the area. An incision of about one to one and a half inches is made in the numbed area. The spermatic bundle (cord) is located, grasped, and brought out of the patient’s body. Using the microscope, the layers of muscle surrounding it are stripped away. The artery is identified and a tie loosely placed around it for identification. The veins are then sequentially located and severed. The cord is then placed back into the patient’s body and the tissues are closed, layer-by-layer. The skin is generally closed with a plastic surgery stitch; the stitches are placed under the skin so that they need not be removed later.