Vasectomy Reversal: Epididymovasostomy Technique

For a vasectomy reversal procedure termed epididymovasostomy, there are also two microsurgical approaches; Dr. Turek is experienced with both. Again, neither procedure has proven superior to the other, although Dr. Turek certainly has a preference for epididymovasostomy surgery.

TECHNIQUE OF "INVAGINATION" EPIDIDYMOVASOSTOMY. NOTE SUTURES ARE PLACED AROUND THE HOLE IN THE EPIDIDYMIS AND NOT THROUGH THE EDGE, WHICH IS TYPICAL OF THE MUCOSA-TO-MUCOSA METHOD.

Overall, the epididymovasostomy procedure involves a similar surgical incision as vasovasostomy; however, the testis is usually delivered into the field for this more complex microsurgery. After the findings from the vasal fluid are reviewed showing epididymal obstruction, the epididymis is exposed by opening the outer testis covering (tunica vaginalis). The epididymis is inspected and an individual tubule selected that Dr. Turek’s experience suggests may contain moving sperm. From this point on, one of two epididymovasostomy procedures is used. In the mucosa-to-mucosa, end to side method of vasectomy reversal, an opened epididymal tubule is microsurgically connected to the cut end of the vas deferens with 4 to 6 small (10-0) simple sutures placed around the circumference of each. This “inner” layer is supported with an “outer” layer of radial 9-0 sutures to strengthen the epididymovasostomy.

Recently, a novel “invagination” epididymovasostomy was described as an alternative to the mucosa-to-mucosa epididymovasostomy. With this procedure, one, two or three “vest” sutures of 10-0 suture are placed near the opening of the epididymal tubule to allow the epididymal tubule to “invaginate” into the vas deferens, theoretically creating an epididymovasostomy with an improved watertight seal and better chances for success. Dr. Turek was an early adopter of this invagination epididymovasostomy method for vasectomy reversal and has had excellent success using it. Once the vas-deferens-epididymis connection is completed, the covering around the testis is replaced and the skin incision closed with absorbable suture.

Postoperative care for epididymovasostomy is basically the same as vasovasostomy. Dr. Turek limits heavy physical activity for 3 weeks after an epididymovasostomy procedure. Occasionally (5%), small, painless rubber drains are placed in the scrotum during the procedure, to minimize any potentially harmful collections of fluid or blood that may accumulate after surgery. Drains are usually painlessly removed the day after epididymovasostomy surgery.

Realize too, that epididymovasostomy is one of the most complex surgical procedures in all of microsurgery. This reproductive tract microsurgery attempts to connect tubes that are less than 1/10th of a millimeter in size. For comparison, an experienced, trained human hand can control movements down to a distance of about 1/30th of a millimeter. In most other kinds of microsurgery, such as microvascular surgery, tubes (blood vessels) are generally 1-2 millimeters or greater in size, an order of magnitude larger than that tackled with a vasectomy reversal involving epididymovasostomy.