V902: ROBOTIC ASSISTED MICROSURGICAL VASOVASOSTOMY
VideoIntroduction and Objectives
Microsurgical vasovasostomy is a technically demanding procedure that requires a high degree of microsurgical training and a skilled surgical assistant. These limitations can potentially be alleviated with robotic assistance where there is a stable ergonomic platform, improved visualization, decreased surgeon fatigue, and less reliance on a surgical assistant. Previous studies have shown possible benefits in the use of robotic assistance for these procedures and comparable patency rates. In this video we will illustrate our video technique for robotic assisted microsurgical vasovasostomy (RAVV).
A total of 133 men underwent vasectomy reversal between August 2007 and October 2012, 80 underwent bilateral RAVV. A five-arm technique was developed utilizing the daVinci Si robot (Intuitive Surgical, Sunnyvale) with a dual 16-18x optical high magnification view (VITOM, Karl Storz Inc, Tuttlingen, Germany). For the vasal muscular layer anastomosis 9-0 nylon suture was used. For the vasal mucosal lumen anastomosis 10-0 double-armed nylon suture was utilized. Semen analysis was obtained at 2, 5, 9 and 12 months post-operatively.
The median patient age was 42 years (23-64). Median follow-up was 21 months (1-47). Median duration from vasectomy was 8 years (1-23). 8 cases were redo-vasectomy reversal procedures (men who had failed a previous microsurgical reversal elsewhere). Patency rate (>1 million motile sperm/ejaculate) was 96% and robotic microsurgical operative duration was 90 min.
The outcomes of robotic assisted microsurgical vasovasostomy appear promising. Patency rates are similar to the standard microsurgical approach. Further evaluation and longer follow up is needed to assess its clinical potential and the true cost-benefit ratio.