Laparoscopic Anatomic Characteristics of Internal Spermatic Veins at the 2 Cm Above Internal Inguinal Ring Area

ABSTRACT Purpose To study the anatomic characteristics of internal spermatic veins, at the 2 cm above internal inguinal ring area, in patients with varicocele undergoing laparoscopic varicocelectomy. Methods The clinical data of 447 patients with primary varicocele in our hospital from January 2014 to December 2024 were collected and retrospectively analyzed. All patients underwent laparoscopic varicocelectomy, and the ligation of the internal spermatic veins was performed 2 cm above the internal inguinal ring. The number of left and right side internal spermatic veins was recorded, respectively. The locations of the internal spermatic veins and testicular arteries were also recorded. Results Under laparoscopy, these internal spermatic veins generally appeared dark red in color, with straight courses, full distension, and the testicular artery often appeared as a tortuous vessel with a bright red color and pulsatility. The lymphatic vessels typically appeared as white, glistening ducts. In 56 patients with left varicocele, the number of internal spermatic veins was 2.29 ± 0.12 at 2 cm above the internal inguinal ring. In 391 patients with bilateral varicocele, the number of internal spermatic veins in the left and right sides was 2.30 ± 0.04 and 2.07 ± 0.04, respectively, and there was a significant difference in the number of internal spermatic veins between these two sides ( p ≤ 0.05). Conclusion The anatomic structure of internal spermatic veins under laparoscopy is clear at 2 cm above internal inguinal ring, and the number of veins and the distribution of arteries have certain characteristics, which contribute to reducing missed veins ligation and avoiding accidental ligation of arteries and lymphatic vessels. Those findings contribute to offer an anatomical basis for improving treatment efficacy and minimizing surgical complications.