Innovative Single-Armed Suture Technique for Microsurgical Vasoepididymostomy

Monoski, Mara A.; Schiff, Jonathan D.; Li, Philip S.; Chan, Peter; Goldstein, Marc

doi:10.1016/j.urology.2007.01.091

Cited by 35 publications

(46 citation statements)

References 16 publications

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“…More recent series indicate that patency rates following VE range from 73% to 100%, depending on technique used and definition of vas patency. (Schiff et al, 2005;Monoski et al, 2007). Furthermore, looking at the published data more carefully, it becomes evident that in subgroup analysis for patients with obstructive intervals of <11 years, patency rates were as high as 80%, resulting in a pregnancy rate of 38% (Kolettis et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

Impact of obstructive interval and sperm granuloma on patency and pregnancy after vasectomy reversal

et al. 2010

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The objective of this study was to determine the effect of the obstructive interval and the presence of a sperm granuloma on vas patency and pregnancy rate following vasectomy reversal. We identified 334 patients with complete follow-up who met the inclusion criteria. There were significant associations between the obstructive interval and procedure performed as well as with patient age. Patients with longer obstructive intervals were more often older (p < 0.001) and more likely to have a vaseoepididymostomy performed (p < 0.001). There was no association between the presence of a sperm granuloma or the length of the obstructive interval with post-operative vas patency and pregnancy rates. The only independent predictor of post-operative fertility was age of the female partner (p = 0.015). Our data clearly demonstrates that when state of the art surgical techniques are used, neither the presence of a sperm granuloma nor the obstructive interval serve as prognosticators of post-operative vas patency and pregnancy rates. However, when counselling patients and their female partners, it is of utmost importance to stress that the age of the female partner is an independent predictor of successful vasectomy reversal.

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Section: Discussionmentioning

confidence: 99%

Impact of obstructive interval and sperm granuloma on patency and pregnancy after vasectomy reversal

et al. 2010

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“…38 The disadvantage is that the placement of two of the four needles on the vasal end has to be done in an outside-in fashion. Two 10-0 sutures are first placed on the vas in an outside-in fashion ( Figure 6).…”

Section: Robotic-assisted Microsurgical Vementioning

confidence: 99%

The evolution and refinement of vasoepididymostomy techniques

Chan¹

2012

Asian J Androl

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Obstructive azoospermia secondary to epididymal obstruction can be corrected by microsurgical reconstruction with vasoepididymostomy (VE). Although alternative management such as epididymal or testicular sperm aspiration in conjunction with intracytoplasmic sperm injection is feasible, various studies have established the superior cost-effectiveness of VE as a treatment of choice. Microsurgical VE is considered one of the most technically challenging microsurgeries. Its success rate is highly dependent on the skills and experience of the surgeons. Various techniques have been described in the literature for VE. We have pioneered a technique known as longitudinal intussusception VE (LIVE) in which the epididymal tubule is opened longitudinally to obtain a larger opening to allow its tubular content to pass through the anastomosis. Our preliminary data demonstrated a patency rate of over 90%. This technique has been widely referenced in the recent literature including robotic-assisted microsurgery. The history of the development of different VE approaches, the preoperative evaluation along with the techniques of various VE will be described in this article.

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“…Although extensive studies have demonstrated the superiority of a two-layer or modified one-layer microsurgical anastomosis in humans [6-8], only a simple, single layer anastomosis was technically feasible in the very thin, proximal rat vas. One of the major difficulties in using the rat model for developing a vas autograft is the predilection of the rat to develop granulomas [4,5].…”

Section: Discussionmentioning

confidence: 99%

“…Advances in microsurgical techniques during the past 30 years have improved the accuracy and success of vas-to-vas and vasoepididymal anastomoses. New modifications, such as the use of biomaterials/sealants, laser soldering, absorbable and nonabsorbable stents, new intussusception vasoepididymostomy (VE) anastomotic techniques, and robotics, are currently under investigation [5-8]. …”

Section: Introductionmentioning

confidence: 99%

Interpositional substitution of free vas deferens segment autografts in rat: feasibility and potential implications

Kadioglu

Temple-Smith

Southwick³

2014

BMC Urol

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BackgroundInsufficient vas length for performing a tension-free vasovasostomy is a problem occasionally encountered by microsurgeons. Herein we evaluated utilization of a non-vascularized vas deferens autograft in a rat model.MethodsSegments of isolated vas deferens, 2.5 cm in length, were used as bilateral autografts in 15 rats. Each autograft was implanted between the two transected ends of vas deferens using end-to-end anastomosis. Fertility, sperm motility, and graft survival was evaluated and compared with the control group.ResultsAt the end of the 3 months, 9/15 (60%) rats were able to breed successfully and 24 (80%) vas grafts were patent and viable. Large granulomata developed at the proximal anastomosis sites in 6 (20%) autografts that failed. Unilateral minimal fluid leakage was observed in 6 (20%) of the proximal (testicular end) anastomosis sites in those rats that were able to breed. Histological evaluations demonstrated that graft survival was associated with mild to severe changes in the structure of the vas autograft. On semen analysis 76% of the sperms in the experimental group had forward motility compared to 78% in the control group (p > 0.05).ConclusionsVas autograft can successfully be performed in a rat model with ultimate breeding capability.

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Innovative Single-Armed Suture Technique for Microsurgical Vasoepididymostomy

Cited by 35 publications

References 16 publications

Impact of obstructive interval and sperm granuloma on patency and pregnancy after vasectomy reversal

Impact of obstructive interval and sperm granuloma on patency and pregnancy after vasectomy reversal

The evolution and refinement of vasoepididymostomy techniques

Interpositional substitution of free vas deferens segment autografts in rat: feasibility and potential implications

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