Introductions and Objectives
Microsurgical vasovasostomy (VV) is a challenging procedure requiring dedicated microsurgical training. Even though success rates are very high with contemporary techniques, there are still a few failures and a number of patients that initially succeed do have anastomotic failures after one year. Short term and long term failures could be attributed to granuloma/scar formation at the anastomosis site. A previous rodent study has shown that using a bio-wrap to cover the VV site significantly reduces granuloma/scar formation at the anastomosis site. This may also have benefits for patients who are undergoing a reversal for post-vasectomy pain. This video illustrates a bio-wrap assisted modified single layer robotic microsurgical vasovasostomy (RMV) technique.

Prospective Institutional Review Board approved study on four RMV patient cases between December 2012 and March 2013. The indication for VV was post-vasectomy chronic testicular pain (failed conservative measures, pain > 1 year) in all four patients. Modified single layer vasal anastomosis utilizing five double arm 10-0 nylon sutures was performed in all cases. The bio-inert matrix material (Axogen Inc., Alachua, FL) was then placed around the anastomosis site and anchored using two 9-0 nylon sutures to the muscularis of the vas deferens on either side of the anastomosis. Preoperative and postoperative pain was assessed using an externally validated pain QOL impact score (PIQ-6), range: 78-severe impact to 40-no impact (QualityMetric Inc., Lincoln, RI). Semen analyses were obtained at the second and fifth months postop.

Three bilateral RMV and one crossover unilateral RMV procedures were performed (crossover procedure was done due to absence of the distal vas deferens on one side from prior surgery). Median duration from vasectomy was 4.5 years (1– 9). Median robotic console time was 30 minutes per side. Median follow up was 8 months. Patency (> 1 million motile sperm per ejaculate) was achieved in all three bilateral RMV patients. No sperm was found in the crossover RMV. All four patients had a significant reduction in pain (78, 78, 69, 68 to 57, 52, 44, 54, respectively at 6 month follow up).

Despite the small sample size of this study, the preliminary outcomes of the bio-wrap assisted RMV technique seem promising.

Funding: None