V07-11 A SINGLE STEP MANEUVER TO SIMPLIFY THE TRADITIONAL EPIDIDYMOVASOSTOMY (EV)

Abstract

You have accessJournal of UrologySexual Dysfunction & Transgender (V07)1 Sep 2021V07-11 A SINGLE STEP MANEUVER TO SIMPLIFY THE TRADITIONAL EPIDIDYMOVASOSTOMY (EV) Jason Kovac Jason KovacJason Kovac More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002034.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urologists perform >500,000 vasectomies in the US every year; of which 6% request reversals. Microsurgical reconstruction, or vasectomy reversal (VR), involves either a vasovasostomy (VV) or EV depending on intra-operative findings. Traditionally, the EV has been described as the more difficult of these two procedures. On occasion, the tension and location of the site of anastomosis makes placement of the 10-0 sutures difficult. Specifically, the step in which the vasa and the epididymis are re-approximated, can strain the 10-0 sutures leading to a difficult, and less-than desirable intussusception.This video abstract demonstrates the placement of a stitch at the 12 o'clock position to improve ease and success of an EV. METHODS: Intra-operatively, given the traditional approach, once the decision to perform an EV has been made, an appropriate site for the end-to-side anastomosis must be identified. The tunica vaginalis is then incised and epididymal tubules exposed. Two, 10-0 double armed stitches are placed into the epididymal tubule. The tubule is opened with a micro-knife confirming presence of sperm. Once the optimal location of EV has been confirmed, the vasa is secured to the epididymal tunic posteriorly with 2-4 interrupted 8-0 (or 9-0) sutures. The 10-0 stitches are pulled through the epididymal tubule and placed into the vasal mucosa thus completing the inner layer of the anastomosis. The 10-0 sutures are tightened thus intussuscepting the mucosal layers to allow an appropriate anastomosis. Additional 8-0 external stitches are placed to complete the connection. RESULTS: The maneuver described in this video consists of a single 8-0 stitch, placed at the 12 o’clock position, connecting the epididymal tunic to the vasal muscularis/adventia PRIOR to the completion of the 10-0 intussusception. Once placed, a double throw knot is incompletely tied, allowing the surgeon to both bring together and hold the vasa close to the epididymis. With this stitch in position, each of the 10-0 stitches are then tied to prevent retraction of the anastomosis. The placement of this 12 o'clock holding stitch decreases the working distance and allows for a tighter, more stable, and improved re-approximation while tying down the fragile 10-0 sutures. Speed is also enhanced since, at the completion of the mucosal intussusception, the 8-0 is already in place. CONCLUSIONS: In cases of a difficult EV featuring a tight, tenuous connection – the placement of the “Kovac stitch” - a single, double thrown, incompletely tied, 8-0 stitch will re-approximate and relax the strain on the EV connection allowing a nice, tight mucosal anastomosis. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e554-e554 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason Kovac More articles by this author Expand All Advertisement Loading ...