New innovative use of 3D video exoscope in microsurgical varicocelectomy: a case series

Introduction: Varicocele affects 10-15% of adult males, and is linked to infertility (35%) and testicular pain (10%). Microsurgical varicocelectomy (MV) is considered the gold standard treatment due to its low complication rates and superior anatomical outcomes. However, conventional MV using a 2D exoscope presents limitations in image depth and surgeon ergonomics. This study presents the use of a 3D video exoscope as a novel tool to enhance visualization and ergonomics during MV.
Materials and methods: We report a series of four patients undergoing 3D-assisted microsurgical varicocelectomy using a Zeiss microscope integrated with a 3D video exoscope system. Patients presented with either infertility, testicular pain, or both, with varicocele diagnoses confirmed by physical examination and ultrasound. Procedures were performed subinguinally with artery- and lymphatic-sparing techniques, and the ergonomics and image quality were assessed.
Results: All surgeries were successfully completed with the aid of the 3D exoscope. Surgeons reported improved ergonomics, reduced neck and back strain, and enhanced image depth and clarity. The system allowed for up to 10x optical magnification, full-screen UHD 3D visualization, and a wide field of view. No intraoperative complications were noted. Patients tolerated the procedure well, and early outcomes were favorable in terms of symptom relief and semen parameter improvement.
Conclusions: The integration of a 3D video exoscope in microsurgical varicocelectomy is a promising innovation. It offers superior image quality, improved surgeon comfort, and may enhance surgical precision. Further studies with larger cohorts and long-term follow-up are warranted to validate these findings.

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