Microscopic Surgery
The following microscopic surgeries may be done to treat a variety of male conditions, including infertility, scrotal pain, and varicoceles.
Micro-TESE
Micro-TESE is a method of extracting sperm in men with non-obstructive azoospermia (NOA). The main sign of this condition is no sperm in the ejaculate caused by issues with sperm production.
Micro-TESE is done to identify pockets of sperm and harvest them within one procedure. It may take some time to find the sperm, but the sperm obtained during the procedure can be incubated into waiting eggs or frozen for future in vitro fertilization (IVF).To locate sperm, the surgeon will search for seminiferous tubules and extract them for analysis by a lab technician. Micro-TESE is done with a small incision in the midline of the scrotum.
Microscopic Denervation of the Spermatic Cord
Patients with scrotal pain may be treated with microscopic cord denervation. During this treatment, the surgeon makes a small incision and uses a surgical microscope to slowly dissect the spermatic cord without harming the testicular artery, lymphatic vessels, and vas deferens. Once the cord is “stripped down” to its essential parts, the surgeon closes the wound.
The procedure may be recommended in the following cases:
- The patient has a history of epididymitis or orchitis.
- The patient has undergone a vasectomy.
- Symptoms haven’t improved after conservative treatment.
Microscopic Varicocelectomy
The procedure can be performed using an inguinal or subinguinal approach. If the surgeon uses the inguinal approach, an incision will be made to access the ilioinguinal nerve. The nerve will be cut and the affected veins will be sealed. The surgeon will also dissect the spermatic cord to access the abnormal veins, which will be sealed or tied. Blood flow will be diverted to the pelvis or inner thigh. This approach is recommended for patients experiencing pain caused by varicoceles.
During surgery using the subinguinal approach, the surgeon makes an incision lower in the groin. The surgeon will take care to not harm the arteries that supply blood to the testicles.
The entire procedure takes about one hour and patients are typically able to return home soon after surgery. The recovery process is about two to three weeks.
Microscopic Vasectomy Reversal
A vasectomy is done to prevent a man’s ability to conceive. The procedure is intended to be permanent, but may be reversed.
A vasectomy reversal connects the vas deferens to the testicles and is done on an outpatient basis. The success rate ranges from 40 to 90 percent, and depends on the age and overall health of the patient.
The patient will be given local or general anesthesia and the surgeon will begin by making an incision on the underside of the scrotum. Then, he will expose the vas deferens and release the tubes from surrounding tissue. The surgeon will cut open the vas deferens to see if there is semen within the tubes.
If the patient has semen in the vas deferens, the surgeon will reconnect the ends of the tubes. But if there isn’t any semen, the surgeon will remove built up scar tissue from the previous vasectomy.
