What are the latest techniques for vasectomy reversal surgery?

Dr. Turek is a dedicated microsurgeon who is always asking: ”How can I improve things?” Are there ways to make vasectomy reversal surgery simpler, patients more comfortable or outcomes better? Since there are always ways to improve things, this kind of thinking really distinguishes an expert from the average doctor. Two recent new techniques in vasectomy reversal surgery that Dr. Turek has either developed or help to popularize are:

INVAGINATION EPIDIDYMOVASOSTOMY

The original epididymovasostomy, performed prior to World War II and before microsurgery, involved placing a half-opened epididymis near the half-opened vas deferens to create a loose connection (termed a “fistula”). It was not very successful. In the late 1970’s a new technique of attaching a single epididymal tubule directly to the vas deferens was proposed; this is what is currently done today. With this technique, the edges of the epididymal tubule are connected to the edges of the vas deferens with suture during vasectomy reversal surgery.

Most recently, the idea of edge-to-edge connections (also termed mucosa-to-mucosa) has been challenged. A new technique, termed invagination epididymovasostomy, that does not use the edge-to-edge connection, has become popular over the last several years. The essential difference between this new technique and the edge-to-edge technique for vasectomy reversal surgery is that the epididymal tubule edge is not sutured to the vas deferens edge. Instead the sutures are placed such that the epididymal tubule is carefully pulled into the hole of the vas deferens or invaginated into it. This new technique uses fewer sutures and appears to be a more leak-free anastomosis than the edge-to-edge approach to vasectomy reversal surgery. Dr. Turek uses this new vasectomy reversal technique as much as possible.

MAGNIFYING LUBRICANTS

Dr. Turek recently invented, studied and published a new technique that uses a novel lubricant to make vasectomy reversals easier to perform. This new technique involves a safe, nonreactive lubricating bulking agent termed Viscoat™ has been used by opthalmologists for years in delicate eye surgery cases.

FIGURE 6. EXAMPLE OF HOW VISCOAT MAGNIFIES THE TYPED LETTER "A" BY ABOUT 1.5 FOLDER UNDER THE OPERATING MICROSCOPE. DR. TUREK NOW USES THIS AGENT IN HIS VASOVASOSTOMY CASES TO MAKE THEM MORE PRECISE.

Dr. Turek has found that when this new technique is used in vasectomy reversal cases, this substance helps make the vas deferens lumen larger for easier suture placement and magnifies the microsurgical view of the vas deferens lumen. It also helps visualize the connection without the need for cautery that can damage tissue. And this benefit comes without any loss of patency rate when compared to vasectomy reversal cases in which Viscoat is not used. This magnifying lubricant has become an important new technique or “tool” in Dr. Turek’s microsurgery cases and is an example of how a master microsurgeon is constantly looking for ways to improve outcomes after vasectomy reversal.

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