Video Technique for Human Robot-Assisted Microsurgical Vasovasostomy

Parekattıl, Sıjo J.; Atalah, Hany; Cohen, Marc

doi:10.1089/vid.2010.0013

Cited by 5 publications

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“…, 2005; Jee & Hong, 2010) and the robotic techniques currently published (Fleming, 2004; Kuang et al. , 2004; Parekattil et al. , 2010).…”

Section: Discussionmentioning

confidence: 99%

Vasectomy reversal using a microsurgical three‐layer technique: one surgeon’s experience over 18 years with 1300 patients

Schwarzer¹

2012

Int J of Andrology

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The technique and the results of microsurgical vasectomy reversal in a single-centre study over 18 years are presented. Both vasovasostomy (VV) and epididymovasostomy (EV) were carried out in a three-layer technique. With strict adherence to the strategy, end-to-end VV was only performed if spermatozoa had been demonstrated at the epididymal stump of the vas. In all other cases, EV was carried out in a preocclusive region of the epididymal tubule. The outpatient procedure of refertilization was associated with a very low complication rate, which underlines its minimal-invasive character. The follow-up rate was 71%, the overall patency rate was 89% and the pregnancy rate was 59%. Secondary azoospermia was only observed in 1% of the patients. In relation to the intervals of obstruction, the patency and pregnancy rates were higher after short-term obstruction than after long-term obstruction. Correspondingly, higher success rates were found after VV than after EV. This is understandable because the probability for indication of EV increases with longer periods of obstruction. There is a significant discrepancy between patency and pregnancy rates that is likely to be caused by a relevant number of patients with post-operative asthenozoospermia. The duration of obstruction is an important factor concerning epididymal damage, but it only disproportionately affects the results of refertilization if the technology of EV is implemented consistently in case of an epididymal granuloma. Good clinical results are achieved with this strategy, as evidenced by pregnancy rates and semen analyses.

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“…, 2005; Jee & Hong, 2010) and the robotic techniques currently published (Fleming, 2004; Kuang et al. , 2004; Parekattil et al. , 2010).…”

Section: Discussionmentioning

confidence: 99%

Vasectomy reversal using a microsurgical three‐layer technique: one surgeon’s experience over 18 years with 1300 patients

Schwarzer¹

2012

Int J of Andrology

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“…[13] Some of the other attempts to simplify this procedure have looked at the option of using fibrin glue with only three sutures or a robotic-assisted procedure. [14–16] Clearly, there is no single technique which is superior to the other.…”

Section: Discussionmentioning

confidence: 99%

"4 x 4 vasovasostomy": A simplified technique for vasectomy reversal

Kumar

Mukherjee

2010

Indian J Urol

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Objectives:An ideal vasovasostomy procedure requires precise mucosal approximation with a watertight anastomosis. The standard two-layer microdot technique requires multiple sutures within each layer and is a technically difficult operation to perform. We describe a two-layered technique which adheres to the principles of tubular anastomosis, but is simpler and provides excellent results.Materials and Methods:Patients with secondary infertility following a previous vasectomy underwent the modified two-layered vasovasostomy. Two 8-0 polyamide sutures were placed at 5 and 7 o’clock positions in the sero-muscular layer to approximate the two ends of the vas. Next, four double-armed, 10-0 polyamide sutures were sequentially placed, inside out in the mucosa of the vasal ends, at 3, 6, 9, and 12 o’clock positions and tied. Two additional sero-muscular sutures were placed at 1 and 11 o’clock positions to complete the anastomosis. Patients with a suspected proximal block in the epididymis underwent a vasoepididymostomy. Semen analysis was performed at 6 weeks after surgery.Results:Between the period February 2008 and August 2009, eight men underwent vasectomy reversal using the 4 × 4 technique. The procedure was performed bilaterally in six men whereas two patients underwent a two-suture, longitudinal intussusception vasoepididymostomy on the second side. Mean operative time was 90 min per patient. All men had sperm in the ejaculate at the first semen analysis. There were no complications.Conclusions:The “4 × 4” modified two-layer vasovasostomy is a simple technique that can be performed in quick time with excellent results. It may allow a common ground between the complex microdot two-layer technique and the over-simplified single-layer procedure.

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“…[27] We performed a prospective control study comparing initial results for RAVV in 20 human cases compared to seven standard microscopic vasovasostomies (MVV) cases by a single fellowship trained microsurgeon from July 2007 to June 2009. [28] A three-layer 10-0 and 9-0 suture anastomosis was performed with up to 22 months follow-up (mean three months). Mean operative duration for the RAVV cases was 109 min and 128 min for MVV ( P 0.09).…”

Section: Historical Timelinementioning

confidence: 99%

Robotic instrumentation: Evolution and microsurgical applications

Parekattıl

Moran

2010

Indian J Urol

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This article presents a review of the history and evolution of robotic instrumentation and its applications in urology. A timeline for the evolution of robotic instrumentation is presented to better facilitate an understanding of our current-day applications. Some new directions including robotic microsurgical applications (robotic assisted denervation of the spermatic cord for chronic orchialgia and robotic assisted vasectomy reversal) are presented. There is a paucity of prospective comparative effectiveness studies for a number of robotic applications. However, right or wrong, human nature has always led to our infatuation with the concept of using tools to meet our needs. This chapter is a brief tribute to where we have come from and where we may be potentially heading in the field of robotic assisted urologic surgery.

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Video Technique for Human Robot-Assisted Microsurgical Vasovasostomy

Cited by 5 publications

References 0 publications

Vasectomy reversal using a microsurgical three‐layer technique: one surgeon’s experience over 18 years with 1300 patients

Vasectomy reversal using a microsurgical three‐layer technique: one surgeon’s experience over 18 years with 1300 patients

"4 x 4 vasovasostomy": A simplified technique for vasectomy reversal

Robotic instrumentation: Evolution and microsurgical applications

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