Objective of the surgery and anatomical landmarks
During surgical treatment of varicocele, when performing resection of the pathologically altered venous bed, the surgeon is obliged to isolate vital elements of the spermatic cord.
During the procedure, it is mandatory to separate and preserve:
- The testicular artery (arteria testicularis);
- Ductus deferens (ductus deferens).
The main anatomical goal of the manipulation is the complete removal of varicose veins while preserving the main arterial blood supply and the excretory duct.
Surgical approach and delivery of the organ
Surgical access is performed layer by layer observing clear topographical landmarks:
- Making the incision. The skin and subcutaneous tissue are incised with a 6–8 cm long incision. The line runs 2 cm above the inguinal ligament (ligamentum inguinale) and parallel to it, extending the incision to the root of the scrotum.
- Delivery of the testis. Through the created access, the testis along with the adjacent spermatic cord is delivered into the wound for subsequent vessel separation.
Technique of vein separation and resection
After delivering the organs into the wound, the procedure proceeds to the main stage of pathological vessel resection:
- Separation. The testicular artery (arteria testicularis) and vas deferens (ductus deferens) are carefully separated from the conglomerate of dilated venous trunks.
- Upper ligation. The altered veins are ligated in the region of the superficial inguinal ring (anulus inguinalis superficialis).
- Isolation. The ligated veins are bluntly dissected downward toward the scrotum.
- Transection. Close to the testis itself, the venous vessels are ligated again and transected.
Fixation of stumps and completion of the procedure
To prevent organ descent and restore normal anatomy, a special fixation technique is used:
- Ligation tying. The free ends of the upper and lower ligatures remaining on the stumps of the resected veins are tied together. This ensures elevation of the testis and its fixation in an elevated position.
- Reposition. The testis is carefully placed back into the scrotum.
- Suturing. Layered sutures are applied to the skin and subcutaneous tissue wound.
Briefly: answers to topical questions
Which tissue layers, in addition to the skin and subcutaneous tissue, are incised during access to the inguinal canal?
During surgical access to the structures of the inguinal canal, in addition to the skin and subcutaneous adipose tissue, the fascial and aponeurotic layers are sequentially incised.
According to the layered structure of the region, these include:
- Superficial fascia (fascia superficialis) — represented by two leaves.
- Aponeurosis of the external oblique abdominal muscle — forms the anterior wall of the canal; after incision, its edges are grasped with clamps and retracted to expose the underlying structures.
Remember the key steps of the surgery via the "A-D-S-R-F-C" chain: Approach (above the inguinal ligament) $\rightarrow$ Delivery (of the testis into the wound) $\rightarrow$ Separation (of the artery and duct) $\rightarrow$ Resection (ligation and transection of veins) $\rightarrow$ Fixation (tying stumps for elevation) $\rightarrow$ Completion (reposition and skin suture).
Class and exam questions
What is the main essence of the surgery for varicocele?
The essence of the procedure consists in the resection of pathologically dilated veins of the spermatic cord.
Where exactly is the surgical incision made?
An incision 6–8 cm long is made 2 cm above the inguinal ligament and parallel to it, extending to the root of the scrotum.
Which structures are separated from the dilated veins before their resection?
The testicular artery (arteria testicularis) and vas deferens (ductus deferens) must be separated from the pathological veins without fail.
How is the elevation of the testis achieved during the surgery?
Elevation of the testis is achieved by tying together the upper and lower ligatures from the ligated venous stumps.
What else to study on this topic
- Topography of the superficial inguinal ring (anulus inguinalis superficialis)
- Anatomical relationship of the elements of the spermatic cord
- Technique of blunt isolation of the venous trunk from the inguinal ring to the testis
- Methods of forming ligature knots during the fixation of vein stumps
- Rules for repositioning the testis into the scrotum and skin suturing technique
Master the complete topic in the "Topographic Anatomy" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Surgeries for Varicocele" and 2,777 more subject pages
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 91 video lessons on the subject
Other topics in the section «Pelvic and Perineal Surgery»
Free video lessons: topographic anatomyShort lessons with study notes — no registration required.
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.