Robotic Assisted Versus Pure Microsurgical Vasectomy Reversal: Technique and Prospective Database Control Trial

Abstract

Microsurgical vasectomy reversal is a technically demanding procedure. Previous studies have shown the possible benefit of robotic assistance during such procedures. Our goal was to compare robotic assisted vasovasostomy and vasoepididymostomy to standard microsurgical vasovasostomy (MVV) and vasoepididymostomy (MVE). The use of robotic assistance for vasectomy reversal may provide the microsurgeon with improved visualization, elimination of tremor, and decreased fatigue and obviate the need for a skilled microsurgical assistant. This study provides the first clinical prospective control trial of robotic assisted versus pure microsurgical vasectomy reversal. The use of robotic assistance in microsurgical vasovasostomy and vasoepididymostomy may have benefit over MVV and MVE with regards to decreasing operative duration and improving the rate of recovery of postoperative total motile sperm counts based on our study.

Robotic surgery: disruptive innovation or unfulfilled promise? A systematic review and meta-analysis of the first 30 years

“…They encompassed a wide range of specialties and procedures (Tables 1, 2). Some articles comprised more than one comparison or study [16–23]. …”

“…These comprised three RCT [26, 76, 77] and 13 prospective [17, 19, 20, 23, 34, 36, 41, 42, 45–47, 49] studies. Meta-analysis showed robotic surgery to increase operative time by 7.3 %, which was significant (95 % CI 1.022–1.124).…”

“…Analysis of the 76 prospective studies revealed that just 47 [16–20, 23, 31–37, 39, 41, 43, 47, 49, 55, 57, 59, 61, 64, 65, 67–71, 75, 85, 86, 88, 89, 91, 94–96, 101, 111–113] of them (61.8 %) had adequate power for outcome evaluation, assuming large effect sizes. For medium effect sizes, 20 studies [31–33, 35–37, 41, 43, 59, 61, 67–70, 75, 85, 86, 95, 111, 112] (26·3 %) were sufficiently powered.…”

WITHDRAWN: The growth of computer-assisted (robotic) surgery in urology 2000–2014: The role of Asian surgeons

“…Oropharynx, base of the tongue or larynx is approached with robotic arms using one of advanced oral retractor systems and a temporary tracheostomy. Robot with its tremor filtration, magnified view and console ergonomics is a wonderful tool for fine suturing alone, even in an open platform, a fact that has found its use in the field of male infertility, for vaso-vasostomy [80] and vasoepididymostomy [81], using as fine suture as 11/O. It took nearly half a decade for the robot to travel to the opposite part of the world, but since then, South Korea has been quick to jump on the robotic bandwagon.…”

Plastic and reconstructive robotic microsurgery – a review of current practices

“…Operative time was faster for robotic cases and patency rates were superior in the robotic cohort, yet did not reach significance [31]. The only comparable human study of the same surgical procedure also illustrated a faster operative time using the robot [44]. Faster, more accurate and less morbid surgery could have an impact on overall health costs.…”