V8-04: Intra-corporeal robotic assisted vaso-vasostomy for the management of bilateral vassal obstruction following inguinal herniorrhaphy with mesh

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Introductions and Objectives
Various surgical approaches have been described for the management of iatrogenic inguinal vasal obstruction, including open microscopic, laparoscopic, and robotic-assisted. Both the open and laparoscopic approaches are often limited in cases of extensive inguinal obstruction or inadequate intra-abdominal vasal length. The robotic approach offers novel opportunities to the operating surgeon, including performing microsurgical anastomoses in traditionally challenging locations. The current communication describes the first intra-corporeal robotic-assisted, microsurgical vasovasostomy (VV) for the treatment of iatrogenic vasal obstruction not amenable to standard microscopic repair.

Methods
Bilateral intra-corporeal, robotic-assisted microsurgical VV’s were performed. The proximal vasa were transected, with obstruction of the distal segments confirmed. Following docking of the robot, the intra-corporeal regions of the vas deferens were transected at the internal ring. The proximal vas segments were then passed intra-corporeally and approximated with 5-0 prolene sutures. A standard two-layer anastomosis was then performed intra-corporeally using 10-0/9-0 sutures.

Results
Total operative time was 278 minutes. No intra- or post-operative complications were noted. Semen analysis obtained eight weeks following the procedure demonstrated a total volume of 5.4cc, 8.4x10^6 sperm/ml, 45.4x10^6 total sperm, and 16% motility, consistent with a successful result.

Conclusions
This represents the first reported case of intra-corporeal outpatient VV. These results demonstrate the feasibility of the procedure and highlight unique aspects of the robotic approach, which may offer advantages over the traditional microscope in select cases.

Funding: none