V1562 A MINIMALLY INVASIVE VASOVASOSTOMY WITH IN LINE VASECTOMY INSTRUMENTS

Abstract

You have accessJournal of UrologyInfertility, Infection, Erectile Dysfunction & Trauma1 Apr 2011V1562 A MINIMALLY INVASIVE VASOVASOSTOMY WITH IN LINE VASECTOMY INSTRUMENTS Joel Marmar Joel MarmarJoel Marmar Camden, NJ More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1585AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES About 500,000 men have vasectomies in the US each year and 3–5% change their minds and seek more children. In the past, the only option for these men was a vasovasostomy (VV). Now,there is sperm extraction and IVF/ICSI, and these procedures have reduced the number of requests for VVs. Therefore, if urologists hope to remain active in the field of microsurgery, it seems important to develop more minilally invasive percedures. This video will demonstrate a minimally invasive VV with In Line Vasectomy (ILV)instruments that offers several advantages. The procedure may be done with a cord block and minimal local to the skin. The procedure is by open access to the vas, and is applicable to men with thick scrotal skin and re do VVs. A mini tenaculum with teeth can enter the 4 mm opening in the scrotal skin to secure the vas scar which is removed to allow the ends of the vasa greater relaxation during the anastomosis. Post operatively, there is much less swelling than a conventional VV, and the patients return to work in about 3 days. METHODS A cord block is completed with 10 cc of 1% xylocaine, and the scrotal skin is numbed with 0.5 cc over the vas scar. A 0.5mm opening is made with a # 15 blade over the vas scar as it is palpated by the surgeon. The mini tenaculum will secure the vas scar in its teeth while a window is dissected in the mesentary above and below the scar. After a hemostat is positioned thru both windows aqnd behind the mesentary, a cautery tip will burn the area below the vas scar to separate it from the mesentary. The vasal ends are cut sharply on either side of the vas scar, and the scar is removed. The ends are stretched apart to create length. The vas fluid was tested for sperm before these structures are placed in a vas holding clamp for a 2 layer VV. Following the anastomosis, the repaired vas is replaced into the scrotum thru the 4mm opening which is closed with 1 stitch. RESULTS Ten men have had bilateral VVs with this procedure. The mean age was 41.3 years. The interval of obsrtuction ranged between 4–11 years. Post operative swelling and pain was about the same as the vasectomy. The men returned to work in 3 days. Nine of 10 demonstrated motile sperm in the ejaculate, and the mean sperm densities were 19 million sperm/ml. There have been 5 live births. CONCLUSIONS A minimally invasive VV with ILV instruments is an effective out patient proceure, and it can be done with a local anesthetic and minimal post op discomfort. Furthermore, this procedure is more cost effective that IVF/ICSI, and it should be offered to men who seek more children after a vasectomy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e627 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joel Marmar Camden, NJ More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...