VASECTOMY REVERSAL – EARLY LEARNING CURVE
Male infertility microsurgery (MIM) is one of the most technically challenging surgeries, requiring intensive microsurgical training. Its surgical outcomes highly depend on surgeon's skills. Although vasectomy reversal (VR) is one of the most difficult microsurgical procedures, it is a cost-effective option for couples desiring offspring after vasectomy. We report the early learning curve results for VR performed by a single surgeon who had a fellowship with extensive MIM training.
We reviewed the charts of 39 consecutive men who underwent VR by a single surgeon during a period of 15 months from June 2016 to September 2017. We divided them into tertiles by time period . We assessed and compared the following variables: surgical time, complications, post-operative sperm total count, and patency. All procedures were performed microsurgically under an operating microscope. A multilayer micro-dot technique was used for vasovasostomies (VV), and the longitudinal intussusception technique was used for vasoepididimostomies (VE).Patients were followed with semen analysis after 4 weeks, and every 3 months thereafter.
There were no differences among groups regarding the baseline characteristics. Men who underwent bilateral VV composed 87%, 92% and 61% of the first, second and third tertiles respectively. The surgical time progressively reduced from the first tertile (226 ± 31 minutes) through the third one (181 ± 15 minutes)(p<0.001). The last two tertiles had slightly higher patency rates than the first group (3rd- 90%, 2nd- 85% and 1st-77 %), and the mean total sperm count also improved through the tertiles (see table), but both differences didn’t achieve statistical significance. One men developed a scrotal hematoma requiring drainage in the second group, and one had a wound infection in the third group. </p>
VR is a challenging procedure that has a steep learning curve, even for a surgeon who had extensive male infertility microsurgical training and fellowship. MIM fellowship training is important to help to accelerate the microsurgical procedure and to reduce the learning curve.