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| Year : 2014 | Volume
: 11
| Issue : 4 | Page : 371-372 |
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| Is it a Palomo's operation? |
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Nitinkumar Borkar1, Nitin K Kashyap1, Debajyoti Mohanty2
1 Department of Trauma and Emergency, AIIMS, Raipur, Chhattisgarh, India
2 Department of General Surgery, AIIMS, Raipur, Chhattisgarh, India
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| Date of Web Publication | 17-Oct-2014 |
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How to cite this article:
Borkar N, Kashyap NK, Mohanty D. Is it a Palomo's operation?. Afr J Paediatr Surg 2014;11:371-2 |
Sir,
We have read the article 'Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents: Comparison between two techniques' by Marte et al. [1] with interest. We congratulate the authors for this nice comparative study that reaffirms the benefits of minimal invasive surgery in the management of this common ailment. Though a wide array of surgical modalities are available for the treatment of varicocele, it is the advent of minimally invasive techniques (laparoscopic varicocelectomy) that had resulted in larger acceptance of surgical means as the treatment of choice. Single incision laparoscopic surgery (SILS) represents a further advance in minimally invasive technique. The indications of SILS are rapidly expanding with the availability of better instruments and surgical expertise.
The authors had compared conventional three-trocar laparoscopic varicocelectomy and SILS Palomo varicocelectomy. Both the procedures follow the same technique except for the mode of trocar placement. We notice that there is a disparity in the terms used for describing the procedures in the title of the article and the patients and methods section.
There is wide spread confusion regarding the exact technical details of Palomo procedure. [2] The original article by Palomo depicts that the procedure was carried out under local anaesthesia. Entry into the retroperitoneum was gained through a 4 cm longitudinal incision, 3 cm above the deep ring and parallel to the poupart ligament. The procedure was completed with ligation and excision of segments of both the testicular artery and vein. While Palomo procedure was completely confined to the extraperitoneal space, laparoscopic approaches necessitate initial entry into the peritoneal space followed by the entry to the extraperitoneal space. This is in contradiction to the original Palomo procedure that had eliminated the risk of intraperitoneal mishaps during the intervention. In the light of the above facts, laparoscopic varicocelectomy should be a more appropriate terminology rather than laparoscopic Palomo varicocelectomy for describing the minimal invasive intervention for varicocele management.
Though varicocele is more common, on the left side, 7-10% of patients can have bilateral varicocele. The authors have not mentioned of the side of varicocele in the operated patients. It is also necessary to mention about the number of bilateral cases in this series as the operating time for a bilateral varicocele is expected to be longer as compared to a unilateral varicocele. This factor can induce bias in the interpretation of the results. Mention of the duration of follow-up period is also missing in this article.
 References | |  |
| 1. | Marte A, Pintozzi L, Cavaiuolo S, Parmeggiani P. Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents: Comparison between two techniques. Afr J Paediatr Surg 2014;11:201-5.  [ PUBMED]  |
| 2. | Palomo A. Radical cure of varicocele by a new technique; preliminary report. J Urol 1949;61:604-7. |
Correspondence Address:
Dr. Nitinkumar Borkar
402, Type 4 A, AIIMS Residential Complex, Kabir Nagar, Raipur - 492 001, Chhattisgarh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0189-6725.143188
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