Video technique for human robot-assisted microsurgical vasovasostomy

Abstract: Previous studies have shown that robot-assisted microsurgical vasovasostomy (RAVV) has technical advantages over pure microscopic vasovasostomy (MVV) in animal and human models. This study presents a video technique and initial results for RAVV in 20 human cases compared with 7 MVV cases by a single fellowship-trained microsurgeon from July 2007 to June 2009. A three-layer 10-0 and 9-0 suture anastomosis was performed with up to 22 months follow-up (mean 3 months). Mean operative duration for the RAVV cases was 109 and 128 minutes for MVV (p = 0.09). At 2 months postoperatively, all patients were patent. Mean sperm count was 54 million in RAVV and 11 million in MVV (p = 0.04). The use of robotic assistance in microsurgical vasovasostomy may have potential benefit over MVV in decreasing operative duration and significantly improving early semen analysis measures. Further evaluation and longer follow-up is needed to assess its clinical potential.
Source: Parekattil SJ, Atalah HN, Cohen MS. Video Technique for Human Robot-Assisted Microsurgical Vasovasostomy [Internet]. J. Endourol 2009 Oct 19. [Epub ahead of print] [PubMed]

Validation of a vasoepididymostomy predictor model: is vasoepididymostomy truly predictable preoperatively?

OBJECTIVE: To validate a vasoepididymostomy (VE) predictor nomogram. DESIGN: Data were collected prospectively. A previously published VE predictor model was then applied to all patients. Predicted outcomes were analyzed with respect to outcomes with consideration of actual procedures performed. The maximum follow-up was 30 months, with a median follow-up of 16 months. SETTING: A tertiary referral center in central Texas. PATIENT(S): One hundred fifteen consecutive patients who underwent vasectomy reversals by the fibrin glue technique were included. RESULT(S): Forty patients who would have been predicted to require VE on one or both sides by the predictor model actually underwent vasovasostomy (VV) bilaterally. Follow-up data were available in 62% of these patients, of which 88% were patent and 52% have achieved pregnancies thus far. Seventy patients who would have been predicted to only require VV by the predictor model underwent VV. Follow-up data were available in 60% of these patients, of which 98% were patent and 36% have achieved pregnancies thus far. The five patients not accounted for included two who would have been predicted to require VV and underwent VE because of intraoperative decision making and three who were predicted to require VE and underwent VE. CONCLUSION(S): The predictor model designed to identify which patients need VE versus those who will need simply VV is not a reliable predictor in our patient population of patients seeking a fibrin glue vasectomy reversal.
Source: Kavoussi PK, Bird ET. Validation of a vasoepididymostomy predictor model: is vasoepididymostomy truly predictable preoperatively? Fertil. Steril 2009 Jul;92(1):180-181. [PubMed]

Minimally invasive vas surgery using a newly designed double-ringed clamp

INTRODUCTION: We have recently designed a novel surgical instrument, a double-ringed clamp (Moon's clamp), with which the vas deferens can be located and isolated both simply and safely while minimizing unnecessary injury to the surrounding tissue. MATERIALS AND METHODS: With the use of the Moon's clamp, we successfully performed 1,140 cases of simplified, minimally invasive vasectomy and 216 cases of mini-incision vasectomy reversals (vasovasostomies) without any significant complications. CONCLUSION: This surgical technique, using Moon's clamp, may be effective in reducing the operative time, the postoperative complications and the recovery time after different types of vas surgeries, such as vasectomy or vasectomy reversal.
Source: Moon H. Minimally invasive vas surgery using a newly designed double-ringed clamp. World J Urol 2009 Jun 19. [Epub ahead of print] [PubMed]