Ces Urol X:X | DOI: 10.48095/cccu2026022

Microscopic subinguinal varicocelectomy using the ORBEYE 4K 3D camera system

Jana Kocháňová Jiří Heráček, Markéta Matějková, Pavel Drlík, Miroslav Záleský

Urologická klinika 1. LF UK a ÚVN – VFN Praha

Introduction: Subinguinal microsurgical varicocelectomy is recommended by the European Association of Urology as the treatment of choice in adult patients due to the lowest rates of recurrence and complications. The main advantages of the microsurgical approach include high optical magnification, reduced risk of hydrocele formation, and low recurrence rates, albeit at the cost of increased technical complexity [1-3]. Our department is equipped with the ORBEYE 4K 3D system (Olympus, Tokyo, Japan), which is primarily used in neurosurgery and otorhinolaryngology. Given its availability and potential applicability in microsurgery, we have also implemented this system into urological surgery in May 2025. ORBEYE 4K 3D is a digital orbital visualization system enabling microscopic imaging of the surgical field in 4K resolution with up to magnification ×26 on a 3D monitor without perceptible latency. The shared display facilitates the involvement of the entire surgical team and provides educational benefits. A major ergonomic advantage is the so-called \"heads-up\" position, which allows for a physiologic posture of the head and cervical spine compared with conventional microscopy or loupe-assisted surgery. The system further offers advanced imaging modes, including fluorescence imaging using indocyanine green and narrow-band imaging for improved visualization of vascular structures [4,5]. These imaging modalities may facilitate the identification of small vascular structures, including lymphatic vessels and small periarterial veins, which may be difficult to dissect during microsurgical varicocelectomy.

Case report: We present the case of a 33-year-old patient with left-sided symptomatic varicocele, manifested by intermittent pain in the left hemiscrotum. Semen analysis revealed oligozoospermia, with a sperm concentration of 4 million/mL, total motility of 44%, and progressive motility of 34%. The patient reported difficulties with conception. Physical examination demonstrated normal bilateral testicular volume, and serum testosterone levels were within the normal range. The remaining urological evaluation was unremarkable. The patient was indicated for microsurgical varicocelectomy using the ORBEYE 4K 3D visualization system. The operative time was 90 minutes, and the procedure was completed without intraoperative complications. The postoperative course was uneventful, and wound healing occurred per primam intentionem. Follow-up semen analysis performed four months after surgery demonstrated an increase in sperm concentration to 13 million/mL, with total motility of 45% and progressive motility of 34%.

Conclusion: The ORBEYE 4K 3D system represents an alternative visualization technology applicable in microsurgical varicocelectomy. Although it is not primarily designed for urological procedures, its use may be beneficial within the context of interdisciplinary collaboration and expansion of a department\'s microsurgical capabilities.

Keywords: microscope – microsurgery – male infertility –ORBEYE – varicocelectomy

Received: July 6, 2026; Revised: August 24, 2026; Accepted: August 31, 2026; Prepublished online: October 29, 2026