TWO-TROCAR LAPAROSCOPIC VARICOCELECTOMY: COST-REDUCTION SURGICAL TECHNIQUE ADEL AL-HUNAYAN, HAMDY ABDULHALIM, ELIJAH O. KEHINDE, EHAB EL-BARKY, KHALEEL AL-AWADI, AND AWNI AL-ATEEQI ABSTRACT Objectives. To describe the technique of two-trocar laparoscopic varicocelectomy and compare it with the standard three-trocar laparoscopic technique in terms of effectiveness, morbidity, and cosmesis. Methods. Two matched groups of patients with left varicocele were recruited. Each group included 30 patients. One group underwent three-trocar and the other two-trocar laparoscopic varicocelectomy. The results of the two approaches were compared. Results. No significant differences were found in terms of mean hospital stay or morbidity between the two-trocar and three-trocar techniques. A significant difference was found in the operative time and proportion of patients needing postoperative parenteral narcotic analgesia in favor of the two-trocar technique. In both approaches, the previously infertile patients had a significant improvement in sperm count and motility (P 0.05). Cosmetically, the trocar wound scars were aesthetically superior using the two-trocar technique. Conclusions. No significant difference was found between two-trocar and three-trocar laparoscopic vari- cocelectomy in terms of effectiveness and morbidity. The cost of an extra 5-mm disposable trocar in the three-trocar technique and the improved cosmesis after the two-trocar technique have made us prefer the latter technique. UROLOGY 67: 461–465, 2006. © 2006 Elsevier Inc. T he mechanism by which varicocele exerts a deleterious effect on testicular function and se- men quality remains unknown. Nevertheless, var- icocele is generally regarded as a significant factor in male infertility and is present in up to 40% of men presenting for an infertility evaluation. 1 Vari- cocelectomy can be accomplished using a variety of approaches, including modified Palomo or high ligation, transinguinal or subinguinal with or with- out magnification, laparoscopic varix ligation, and transvenous percutaneous occlusion. Laparoscopic varicocelectomy was introduced in the early 1990s as an alternative to the Palomo varicocelectomy. 2 The complication rates are relatively low for this proce- dure, except for the hydrocele rate, which has been similar to that encountered with the open Palomo approach. 3 Laparoscopic varicocelectomy has been performed using the intraperitoneal, preperito- neal, and lumbotomy approaches with almost the same results as those obtained with the Palomo procedure. 3 In the standard intraperitoneal ap- proach, three trocars have been used: two operat- ing trocars and one trocar for the camera. 4 Because smaller ports result in a quicker recovery, 5 fewer trocars could result in a quicker convalescence. In this report, we describe a two-trocar technique for laparoscopic varicocelectomy and compare the re- sults with those for three-trocar laparoscopic varico- celectomy. MATERIAL AND METHODS SELECTION CRITERIA Between June 2003 and December 2004, 82 consecutive patients with varicocele were treated at the Department of Surgery, Urology Unit, Mubarek Al-Kabeer Teaching Hospi- tal, Kuwait. Sixty patients with left-sided varicocele consti- tuted the population of the present study; the others, with either bilateral or right-sided varicocele, were excluded. The The material used in this report was presented in a moderated poster session during the Société Internationale d’Urologie Con- ference, October 2004, Hawaii. From the Department of Surgery, Division of Urology, Mubarak Teaching Hospital and Kuwait University Faculty of Medicine, Safat, Kuwait Reprint requests: Adel A. Al-Hunayan, M.D., Department of Sur- gery, Division of Urology, Kuwait University Faculty of Medicine, P.O. Box 24923, Safat 13110, Kuwait. E-mail: alhunayan@hsc. edu.kw Submitted: March 1, 2005, accepted (with revisions): Septem- ber 29, 2005 ADULT UROLOGY © 2006 ELSEVIER INC. 0090-4295/06/$32.00 ALL RIGHTS RESERVED doi:10.1016/j.urology.2005.09.049 461