Vasectomy Reversal: Vasovasostomy Technique

For a vasovasostomy, two microsurgical approaches are possible and Dr. Turek has extensive experience with both. Neither has proven superior to the other. 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. 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 approaches are shown in the figure below.

For this discussion, we will continue outlining the 2-layer method. The two 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. 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):

	VASOVASOSTOMY AFTER "BACKWALL" OUTER AND INNER SUTURES ARE PLACED, WITH REMAINING INNER SUTURES PLACED BUT NOT TIED.
	VASOVASOSTOMY AFTER ALL INNER SUTURE HAVE BEEN PLACED AND TIED. REMAINING OUTER SUTURES STILL NEED TO BE PLACED.
	VASOVASOSTOMY AFTER ALL INNER AND OUTER VASAL SUTURES HAVE BEEN PLACED AND TIED.

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. 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 on the patient and he is prepared for discharge. The local anesthesia keeps the surgical area numb for 2-4 hours after the procedure. Dr. Turek’s patients take an average of 6 pain pills over the next several days after 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 to 2 or 3 weeks, depending on whether a vasovasostomy or epididymovasostomy is performed.

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