Validation of robot-assisted vasectomy reversal

Abstract

Vasectomy reversal (VR) has traditionally been performed with the operative microscope. Recently, robot assistance has been applied to VR. Retrospective chart review from a single VR center included men who underwent either robot-assisted VR (RAVR) or microsurgical VR (MVR) by a single fellowship trained microsurgeon between 2011 and 2013 and had a 6 weeks postoperative semen analysis. Fifty-two men who were interested in VR were counseled and given the option of RAVR versus MVR. Twenty-seven men elected to have MVR while 25 men elected RAVR. These included vasovasostomies and vasoepididymostomies in both groups, as well as redo VRs in men who had failed previous VR attempts by other surgeons. There was no statistically significant difference between the microsurgical group and the robot-assisted group, respectively, in overall patency rates (89% vs 92%), 6 weeks post-VR mean sperm concentrations (28 million ml−1 vs 26 million ml−1) or total motile counts (29 million vs 30 million), or mean operative times (141 min vs 150 min). There was a statistically significant difference in anastomosis time (64 min vs 74 min), however, clinically this only represented a 10 min longer anastomosis time in the early robotic experience, which was found to be decreasing as the case series continued. Transitioning from MVR to RAVR is feasible with comparable outcomes.

Vasovasostomy and vasoepididymostomy: Review of the procedures, outcomes, and predictors of patency and pregnancy over the last decade

“…The outcomes of the VV and VE that have been reported over the last 10 years are summarized in Table . The number of patients ranged from 25 to 1303.…”

“…The operating time was 120 minutes and the semen analysis after 3 months showed 120 × 10 6 viable spermatozoa per mL. As these initial cases were reported, some institutes also reported the operative outcomes of RAVV and robot‐assisted vasoepididymostomy (RAVE) …”

“…A zero‐degree lens is used and 2 black diamond forceps are attached as needle drivers. Some surgeons performed a 1‐layer anastomosis . The vasal anastomosis was completed by using 9‐0 nylon sutures incorporating both the mucosal and serosal layers.…”

“…The RAVV has a short history as an operative method for vasal reanastomosis; thus, there are only a few reports with a small number of patients. Table shows the outcomes of the RAVV and RAVE . The number of patients ranged from 20 to 65 years in these studies.…”

“…These features might provide surgeons with an advantage in performing complex microsurgical anastomoses. One group also validated robot‐assisted vasectomy reversal (RAVR), including RAVV and RAVE . In the report, there was no significant difference in the operative duration between the RAVR group (150 minutes) and the MVR group (141 minutes) ( P = .3).…”