What is most important for success, however, is that the surgeon use high-power optical magnification to perform the procedure, as success rates have definitely been shown to be higher with the use of an operating microscope.
Please note that content below includes some graphic images of the procedure. If you are ready to schedule a consultation for your vasectomy reversal, please request a consultation here.
One surgical approach is the modified 1-layer connection (anastomosis) and the other is a formal, two-layer anastomosis. The technical differences in suture placement between these two techniques are shown in the figure below.
Vasovasostomy Step-by-Step With Images
For this discussion, we will outline the 2-layer method. The freshened ends of the vas deferens are brought closer by placing small sutures (size 7-0) in the tissue around the vas deferens, thus drawing them together. A vas-approximating clamp can also be used. Once the two ends of the vas face each other, the formal microsurgical connection is begun. First the “back wall,” outer (serosal) sutures (size 9-0) are placed, tying the knots on the outside to protect the lumen. Then, the inner (mucosal) layer of sutures is placed with ultrafine (10-0) suture. Vasectomy reversalist Dr. Turek uses 6 such sutures within the lumen, locating them approximately every “2 o’clock” (or every 60 degrees) around the circumference. The first three are placed and tied, in a manner that helps “triangulate” the vasal lumen to facilitate optimum placement of the remaining sutures (see figure below):
Then, the remaining inner layer sutures are placed, followed by the remaining outer layer sutures to complete the 2-layer connection. This is in turn buttressed with more sutures (size 7-0) placed circumferentially around the sheath of the vas deferens to further strengthen the connection. Larger sutures (5.0) are placed around the vas deferens after that, all to create a tension-free vasal connection. The vas deferens is then placed back into the scrotum and local anesthesia given to ensure a comfortable and pain-free recovery. A similar procedure is performed on the opposite side through a corresponding incision. A scrotal support is placed and the patient prepared for discharge. The local anesthesia keeps the surgical area numb for 2-12 hours after the procedure.
After Your Vasovasostomy
During the recovery phase, the care really kicks in. All patients are followed daily or every other day through a proprietary online portal used by Dr. Turek in which 2-way communication is possible. Patient’s take an average of 6 pain pills over the next several days following the procedure and can return to light activity (short walks, working at desk) within 3 days. Heavy physical activity, including sexual intercourse or sports, is limited for 2 or 3 weeks, depending on whether a vasovasostomy or epididymovasostomy is performed. More details in our vasectomy reversal patient information.