Laser-Assisted Vasal Anastomosis in the Rat and Man

Abstract

In order to study the efficacy of laser-assisted vasal anastomosis (LAVA), a microscopic carbon dioxide surgical laser (Xanar) was utilized in the anastomoses of human vas deferens in vitro and the Sprague-Dawley rat vas deferens in vivo. The longitudinal tensile and internal hydrostatic pressure strengths of laser-assisted vasal anastomoses were compared to conventional microsurgical suture anastomoses in the human vas deferens. The LAVA group had a greater mean internal hydrostatic pressure strength (p < 0.001) and a lesser mean longitudinal tensile strength (p < 0.001) than the conventional microsurgical group.Further evaluation was performed in the Sprague-Dawley rat model, comparing post-operative fertility, patency, healing and sperm granuloma occurrence among four surgically treated groups and a control group: LAVA, conventional suture anastomosis, sham operated, and vasectomized. Light and scanning electron microscopic examination revealed equivalent healing in both the LAVA and conventional groups. Fertility was not statistically different in the LAVA, conventional, control, and sham operated groups. However, the incidence of gross sperm granulomas observed in the LAVA group (80%) was much higher than in the conventional suture anastomosis group (0%). In conclusion, laser-assisted vasal anastomosis is a fast and simple technique for vasal reanastomosis and was as successful (in pregnancies) as conventional suture anastomosis in producing fertility in rats undergoing vasal reanastomosis, but the incidence of sperm granuloma is higher.