V8-05: Single Incision Vasectomy Reversal (SIVR)
VideoIntroductions and Objectives
With the goal to reduce surgical morbidity following vasectomy reversal (VR), the current video highlights the Single Incision Vasectomy Reversal (SIVR) - An innovative approach to VR by which the entire procedure is performed through a single midline mini-incision.
A SIVR was considered in the absence of significant vasal gaps, large sperm granulomas, and/or limited mobility of the scrotal contents. As in the no-scalpel vasectomy (NSV), the SIVR begins by stabilizing the vas directly under the scrotal skin at the midline raphae. The NSV ring clamp is used to capture the vas in the midline at the vasectomy occlusion site. A single small (
Of 104 consecutive vasovasostomy VR, a SIVR was attempted in 24 patients (23%). Mean patient age was 39 years (range: 29-48) with a mean vasal obstructive interval of 5.2 years (range: 3 months-11 years). Post-operative semen parameters and/or a confirmed pregnancy was available in 15 men. Patency (motile sperm) was established in all patients. Mean sperm concentrations and % motile sperm were 27 million/ml and 56%, respectively. Operative time is reduced due to efficiency of wound closure. In one patient, a superficial hematoma was identified that resolved with conservative management.
A SIVR is feasible in well-selected men undergoing vasovasostomy without compromising patency rates or semen parameters. Minimizing the number and size of the incisions and the degree of surgical dissection involving the spermatic cord and testis may translate into less postoperative discomfort and quicker functional recovery.