Majzoub, A, Al Malki, A, Arafa, M, El Bardisi, H

Microsurgical subinguinal varicocelectomy (MSV) is believed by many to be the gold standard approach for treating varicoceles, offering several advantages over other surgical or radiographic techniques. This minimally invasive procedure minimizes recurrence and hydrocele formation while promoting faster, less painful recovery. Testicular artery preservation has been debated historically, however the advancements witnessed in microsurgical techniques and intraoperative Doppler technology allowed for precise identification and sparing of the spermatic artery, reducing the risk of testicular atrophy. We aim in this video to present our surgical technique for MSV utilizing a micro forceps which allows (1) the precise identification of the vascular content of the spermatic cord, (2) separation of the vasal sheath from the surgical field, (3) systemic dissection, ligation and cutting of internal spermatic veins, and (4) superior ability to preserve the internal spermatic artery and lymphatics.