Laparoscopic Palomo procedure: The impact of internal spermatic artery ligation on testicular blood flow

Objective: To assess whether ligation and division of both the internal spermatic vein and artery (Palomo procedure) may cause significant change in the testicular blood flow. Methods: Laparoscopic correction of varicocele without preservation of the internal spermatic artery (ISA) was performed in 21 pediatric patients. Color Doppler sonography was used to measure the resistance index (RI) before and 3 months after the surgery. We measured the RI on the side of varicocele and in the contralateral testis. These data were compared for each patient. Results: The mean operating time was 32 ± 1.82 minutes. Complete correction of varicocele was achieved in 18 (86%) of the 21 boys. In three patients, the varicocele persisted but was significantly reduced in size. Mild hydrocele developed in two patients. The mean RI after the operation did not differ significantly from the preoperative value. An increased RI was noted preoperatively on the side of varicocele. An insignificant rise in the RI was noted in the patients with persistent varicocele and testicular discomfort. Conclusions: The RI was significantly increased preoperatively on the side of varicocele. Our results failed to show any significant change in the RI after ISA ligation. The laparoscopic technique with ligation of the ISA is a safe alternative to ISA preservation.