Learning curve in microdissection testicular sperm extraction: a single surgeon experience
Franceschelli, A1; Gentile, G1; Vagnoni, V 1; Fiorillo, A2; Colombo, F1
1: Andrology Unit, Dept. of Urology and Gynecology, University Hospital s.Orsola, Italy.; 2: Dept. of Urology and Gynecology, University Hospital s.Orsola, Italy.
Objectives: Microdissection testicular sperm extraction (micro-TESE) is currently considered the "gold standard" treatment in patients with nonobstructive azoospermia (NOA). This surgical operation requires some microsurgical skill; for this reason we hypothesized that sperm retrieval rate (SRR) depends on the number of procedures performed
Materials and Methods: From January 2012 to June 2017, 122 patients (mean age 36. 2 years, range 16 – 51; mean FSH 28 IU/l range 7 – 110 IU/l) with NOA underwent micro-TESE performed by a single surgeon in our department. Standard surgical procedure provides equatorial albuginea opening and total parenchyma examination with the use of the operating microscope and with high power magnification, according to Schlegel's technique. Patients were divided into three groups: the first 50 patients (group A), the mid 50 patients (group B), and the last 22 patients (group C); moreover, SRR was investigated according to the year of activity.
Results: Global SRR was 43.8% (53/122 patients). In Group A (mean age was 34.2 years while mean FSH was 20 IU/l), SRR was 26% (13/50 patients), in Group B (mean age 35.1 years, mean FSH 22 IU/l), SRR was 54% (27/50 patients) while in Group C (mean age 33,6 years, mean FSH 24 IU/l) SRR was 59% (13/22) patients) with a progressive and significant increase in SRR among the three group of patients (p=0.004). Moreover, considering the year of activity, SRR resulted 24.3%, in 2012, 28.6% in 2013, 42.9% in 2014, 60.0% in 2015, 61.9% in 2016 and 60.0% in 2017 (p=0.01). We explain this remarkable and significant increase in SRR since 2015, because we have almost always used the highest power magnification with our operating microscope, 36X , that maybe has allowed us to better identify the seminiferous tubules that are most likely to contain sperm
Conclusions: Microdissection testicular sperm extraction (micro-TESE) requires microsurgical skill and a learning curve is needed to obtain high sperm retrieval rate. SRR is influenced by surgeon's volume and experience. In our series we have a significant increase in SRR after the first 50 patients. Moreover as the skill increases, surgeon can use the highest power magnification that maybe allows better identification of seminiferous tubules that are most likely to contain sperm
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