Overall, the epididymovasostomy procedure involves a similar surgical incision as vasovasostomy; however, since this is more complex surgery, the epididymis is exposed through a small opening the outer testis covering (tunica vaginalis). Dr. Turek prefers to do this “in situ” without disturbing the testicle whenever possible. 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.
1. Mucosa-to-Mucosa Method
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 (Figure 1). This “inner” layer is supported with an “outer” layer of radial 9-0 sutures to strengthen the epididymovasostomy (Figure 1).
2. Invagination Epididymovasostomy Method
Recently, a novel “invagination” epididymovasostomy was described as an alternative to the standard mucosa-to-mucosa epididymovasostomy. With this procedure, one, two or three “vest” sutures of 10-0 suture are placed near the opening of the 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 (Figure 2). 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. Read Dr. Turek’s research on invagination epididymovasostomy.
Postoperative care for epididymovasostomy is basically the same as vasovasostomy. Dr. Turek limits heavy physical activity for 3-4 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. Read also our patient information for before and after the 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.
Dr. Turek’s Research on Epididymovasostomy Microsurgery
- The Need for Epididymovasostomy at Vasectomy Reversal Plateaus in Older Vasectomies
- The Kinetics of the Return of Motile Sperm to the Ejaculate After Vasectomy Reversal
- Comparison of Standard and Invagination Microscopic Epididymovasostomy Techniques
- Does Epididymal Induration Predict the Need for Epididymovasostomy at Vasectomy Reversal?
- Invagination Epididymovasostomy During Vasectomy Reversal
- Does the Need for Epididymovasostomy Relate to the Patient Age at the Time of Vasectomy?