(334) Robotic Transabdominal Vasovasostomy Following Laparoscopic Vasectomy: A Case Series

Abstract

Abstract Introduction A small subset of men undergoing laparoscopic hernia repair will request concomitant vasectomy, which is typically performed via resection of a segment of the intra-abdominal vas deferens near the inguinal ring. Some of these men will ultimately desire vasectomy reversal to restore fertility or alleviate post-vasectomy pain syndrome. Traditional scrotal or inguinal microsurgical techniques are clearly not feasible in this situation, and open surgical repair carries significant morbidity. The use of a robotic approach may offer an attractive alternative to improve visualization and facilitate a patent intra-abdominal anastomosis. Objective To demonstrate technical feasibility and report institutional outcomes of robotic-assisted laparoscopic transabdominal vasectomy repair Methods IRB approval was obtained. A retrospective chart review of our institutional experience with this operation was performed. Preoperative, operative, and postoperative data was collected. Results Three cases were identified with a mean patient age of 43 and mean interval of 6 years (range 3-10 years) between vasectomy and reversal attempt. Two men desired restoration of fertility, and one man desired reversal for testicular pain. All patients had previously fathered children, and mean partner age was 30 years. Port placement was similar to standard W-configuration used for robotic prostatectomy. Mean operative time was 319 minutes and estimated blood loss was 27mL. Two men required a modified Prentiss maneuver to re-route the vas deferens to obtain additional length. Indocyanine green was used in one case to confirm vasal perfusion. Bilateral vasovasostomy was completed in all cases with either a modified one-layer anastomosis using 8-0 nylon or a two-layer anastomosis using 10-0 and 9-0 nylon. Both men undergoing fertility restoration had return of sperm in the ejaculate with a mean concentration of 62 million sperm/mL, and the solitary patient with pain had subjective resolution of his pain. Conclusions Robotic transabdominal vasectomy reversal is technically challenging but feasible with an experienced team including a robotic surgeon and andrologist. Outcomes appear to be satisfactory. This technique may be considered for men who have undergone abdominal vasectomy and desire restoration of fertility or treatment of post-vasectomy pain syndrome. Disclosure No