V3-09: Epididymovasostomy: A Two-Suture Intussusception Approach

Video

Introductions and Objectives
Urologists perform over 500,000 vasectomies a year in the United States. Of these men, over 6% will desire vasectomy reversal. During surgery, the decision to proceed with vaso-vasostomy (VV) or epididymovasostomy (EV) depends on the effluent fluid and the microscopic findings assessed from the testis end of the vas deferens. One should consider performing an EV when there is a lack of sperm seen microscopically, especially in the setting of poor vasal fluid quality. We demonstrate the step-by-step microsurgical approach to the epididymovasostomy utilizing a two-suture intussusception technique by an experienced urologic micro-surgeon.

Methods
This surgical technique video demonstrates an EV approach utilizing an intussusception technique of the abdominal vas deferens through the tunica albuginea. The abdominal vas is then anchored to the epididymal tunic. After dilated epididymal tubules are identified two 10-0 sutures are preplaced into this tubule prior to creation of an epididymotomy. The anastomosis is then completed using a near-near far-far suture pattern.

Results
Microsurgical vasovasostomy and epididymovasostomy by a fellowship-trained urologic micro-surgeon yields superior results than macrosurgical approaches, particularly when epididymovasostomy is indicated. The recent success rates in epididymovasostomy can be attributed to improvements in operative technique, instrumentation, and optics. The patency rate of our two-suture intussusception EV technique is 85% with a 45% pregnancy rate.

Conclusions
The success rate of vasectomy reversal depends on time interval from vasectomy, intra-operative findings and subsequent reversal procedure chosen. The surgical technique demonstrated here of EV using a two suture intussusception is more technically demanding than a standard VV and requires an experienced micro-surgeon.

Funding: None