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V82: New transscrotal approach for robotic microsurgical denervation of the spermatic cord with robotic microsurgical varicocelectomy

Speaker
A. Gudeloglu, Ankara (TR)
Authors
Gudeloglu A. 1 , Etafy M. 2 , Brahmbhatt J. 2 , Parekattil S. 3
Institutions
1Hacettepe University Medical Faculty, Dept. of Urology, Ankara, Turkey, 2PUR Clinic , Dept. of Urology, Clermont, United States of America, 3PUR Clinic, Dept. of Urology, Clermont, United States of America, 4
Event
33rd Annual EAU Congress Copenhagen
Date – time - Location
19 March 2018, 15:45 - 17:15, Green Area, eURO Auditorium (Level 0)
Session
Video Session 11 - Complex reconstructive genital surgery
Topic
New experimental technologies and techniques

Introduction & Objectives

Microsurgical denervation of the spermatic cord (MDSC) is a treatment option for chronic orchialgia. Up to 20% of patients may develop chronic postoperative subinguinal incisional pain after traditional MDSC. This video illustrates a novel technique and outcomes for a robotic assisted targeted MDSC approach (RMDSC) and varicocelectomy by using Transscrotal approach to avoid any incisional groin pain.

Materials & Methods

A transscrotal robotic microsurgical approach was developed and performed by using the daVinci Xi robot (Intuitive Surgical, Sunnyvale, CA) in 15 patients (6 RMDSC and 9 RMDSC plus varicocelectomy) from March’17-Sep’17. Selection criteria for the procedures: Chronic testicular pain (>3 months), failed standard conservative treatments and negative urologic workup. Pre and post-operative pain was assessed utilizing a standardized externally validated pain assessment tool - PIQ-6 (QualityMetric Inc., Lincoln, RI) and also visual analog scale (VAS). Pain scores were recorded preoperatively and then postoperatively at 1, 3 and 6 months.

Results

Median OR time was 71 minutes for RMDSC and 116 minutes for RMDSC plus varicocelectomy. 73% (11/15) of the patients had a significant decrease in their pain within limited (median 3months) follow up time (Table 1). Scrotal incisions healed with less scar than standard sub-inguinal incisions and none of the patients reported numbness and pain in the incision site. Two patients developed scrotal hematoma that resolved spontaneously. 
Table 1. Shows the initial result of our new approach

  Group1 Neurolysis only Group 2 Neurolysis + varicocelectomy
Number of Patients 6 9
Causes of pain
- idiopathic
- post vasectomy
 
3
3
 
7
2
Median OR time (mins) 71 116
Complication 1 Wound infection 2 Scrotal hematoma
Median F/U (months) 4 5
Results
-Pain relief
 
4
 
7

Conclusions

We report the first use of a transscrotal approach for robotic Microsurgical denervation of the spermatic cord and varicocelectomy. The outcomes appear promising. A better cosmetic result without groin pain might be a clinical benefit of this novel approach but further experience to fully evaluate its benefits and limitations is required.