- Email: [email protected]
P-648
intra-operative vein size may be useful additional predictors of varicocelectomy outcome. Supported by: None
P-649 BIOGLUE AND DERMABOND SAVE TIME AND LEAK LESS THAN SUTURED MICROSURGICAL VASOVASTOSTOMY. C. Zapanta, A. Abou-Elella, M. Saunders, C. Baxter, J. Trussell. Hershey Medical Center, Hershey, PA.
CONCLUSION: A multi-layered RAVV can be performed in an ex vivo human vas model. Patency rates for RAVV and MAVV were comparable, and the technology removes all tremors. The RAVV operative times were significantly increased, and controlled clinical studies are needed to define what role robotics will have in male infertility reconstructive microsurgery. Supported by: Cleveland Clinic, Intuitive Surgical Educational Grant
P-648 CLINICAL, SONOGRAPHIC, AND INTRA-OPERATIVE ASSESSMENT OF VARICOCELES: DOES THE DATA CORRELATE? G. J. Wang, J. D. Raman, J. Rosoff, M. Goldstein. New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY. OBJECTIVE: There are no prior studies correlating clinical grade, preoperative sonographic vein size, and intra-operative vein size measured at the time of microsurgical subinguinal varicocelectomy. The purpose of this study was to compare varicocele grade and pre-operative sonographic data with intra-operative vein size at the time of varicocelectomy. DESIGN: This is a prospective, non-randomized review of 64 consecutive men who underwent microsurgical subinguinal varicocelectomy. MATERIALS AND METHODS: A total of 64 consecutive men (mean age 34.5 yrs) were enrolled in this study. Twenty-six underwent unilateral microsurgical subinguinal varicocelectomy, of which 23 were left and 3 right. The remaining 38 patients underwent bilateral varicocelectomy for a total of 102 varicocele units. Varicoceles were clinically graded I-III. Pre-operatively, 53 varicocele units had sonographic size available. At surgery, the diameter of the largest internal spermatic vein at the external inguinal ring was measured using a sterile micro-ruler prior to ligation. RESULTS: For clinical grade I varicoceles, the mean sonographic size (n⫽15) was 2.7 mm (⫾ 0.7), and the mean intra-operative size (n⫽20) was 3.5 mm (⫾ 0.9). For grade II varicoceles, the mean sonographic size (n⫽21) was 2.4 mm (⫾ 1.2), and the mean intra-operative size (n⫽42) was 3.7 mm (⫾ 0.9). For grade III varicoceles, the mean sonographic size (n⫽17) was 3.5 mm (⫾ 1.5), and the mean intra-operative size (n⫽40) was 5.2 mm (⫾ 1.6). Using analysis of variance (ANOVA) with Scheffe multiple comparison adjustment, clinical grade was predictive of intra-operative vein size (p⬍0.0001). Intra-operative vein size for grade III varicoceles was significantly larger than that of grades I and II varicoceles (p⬍0.0001). There was no significant difference in intra-operative size between grades I and II (p⫽0.78). Clinical grade was also predictive of sonographic vein size (p⫽0.03). However, this correlation was only significant between grades II and III varicoceles after post-hoc adjustment (p⫽0.03). There was no significant linear correlation between sonographic and intra-operative vein size (r2 ⫽ 0.12, p ⫽ 0.38). CONCLUSION: Clinical varicocele grade is predictive of intra-operative vein size. Clinical grade is also predictive of pre-operative sonographic varicocele size, although this difference is only significant between grades II and III varices. There was no significant correlation between pre-operative sonographic vein size and intra-operative vein size. Sonographic and
S374
Abstracts
OBJECTIVE: To compare time reduction, patency, and leak-resistance of tissue sealants to standard vasovasotomy suture techniques. DESIGN: The gold standard for performing a vasovasostomy is a layered microsurgical anastamosis. Fibrin glue has been used in previously published studies to reduce operative time while maintaining patency. A recent Medline search revealed no studies testing other tissue adhesives such as BioGlue or Dermabond. This study not only compared the operative time needed for suturing/gluing a prepared vas, but also tested the anastamosis for both patency and leakage. MATERIALS AND METHODS: Bull vasa were cut into 6 centimeter lengths and then divided in half to simulate a vasectomy. 4 vas segments used for each of the 5 anastamotic techniques. A dissecting microscope was used to assist with the following: (1) a 2-layer anastamosis consisted of 6 (10-0) mucosal sutures and 6 (9-0) muscularis sutures, (2) a modified 1-layer anastamosis consisted of 6 transmural sutures and 6 muscularis sutures (all 9-0), and (3) a glue reinforced anastamosis supported by 3 evenly spaced transmural (9-0) sutures. A stop-watch was used to time the placement of sutures and then glue application (applied circumferentially). For storage, the vasa were kept in normal saline at 36 degrees F. One vasal tip was gently dilated with a jeweler forcep to allow insertion of a 24 gauge angio-catheter. Saline was used verify anastamotic patency. Next, the opposing vasal end was occluded, and a Laveen syringe was used to test for anastamotic leakage. Finally, microscopy was performed to check for the presence of any glue within the vasal lumen. RESULTS: The mean operative time was greatest for the 2-layer anastamosis. The modified 1-layer technique took less time– but did not reach statistical significance . On the contrary, a significant time reduction was noted when glue was used to reinforce a 3-suture anastamosis. All anastamotic techniques were patent, and on microscopic analysis, none of the glue-reinforced specimens had contaminated the lumen. Regarding leak testing, BioGlue and Dermabond did better than both Fibrin glue and the 2 suture techniques. By grouping the 3 different glue techniques and the 2 different suture techniques, an exact logistic regression model was performed using an odds ratio of 95%. The odds of leaking were 1.6 times higher in the surgery group compared to the glued group. This difference, however, was not statistically significant (95% confidence interval for odds ratio [0.2, 15.7]; p-value ⫽ 0.93).
CONCLUSION: A glue reinforced vasovasostomy anastamosis is significantly less time-consuming than standard suture techniques. Additionally, BioGlue and Dermabond are much more leak-resistant than either Fibrin glue or the sutured techniques. Although previous research shows that Fibrin glue successfully reinforces vasovastomies, the results found in this study suggest that BioGlue or Dermabond may offer even better results. Supported by: None
Vol. 86, Suppl 2, September 2006
P-649 BIOGLUE AND DERMABOND SAVE TIME AND LEAK LESS THAN SUTURED MICROSURGICAL VASOVASTOSTOMY. C. Zapanta, A. Abou-Elella, M. Saunders, C. Baxter, J. Trussell. Hershey Medical Center, Hershey, PA.
CONCLUSION: A multi-layered RAVV can be performed in an ex vivo human vas model. Patency rates for RAVV and MAVV were comparable, and the technology removes all tremors. The RAVV operative times were significantly increased, and controlled clinical studies are needed to define what role robotics will have in male infertility reconstructive microsurgery. Supported by: Cleveland Clinic, Intuitive Surgical Educational Grant
P-648 CLINICAL, SONOGRAPHIC, AND INTRA-OPERATIVE ASSESSMENT OF VARICOCELES: DOES THE DATA CORRELATE? G. J. Wang, J. D. Raman, J. Rosoff, M. Goldstein. New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY. OBJECTIVE: There are no prior studies correlating clinical grade, preoperative sonographic vein size, and intra-operative vein size measured at the time of microsurgical subinguinal varicocelectomy. The purpose of this study was to compare varicocele grade and pre-operative sonographic data with intra-operative vein size at the time of varicocelectomy. DESIGN: This is a prospective, non-randomized review of 64 consecutive men who underwent microsurgical subinguinal varicocelectomy. MATERIALS AND METHODS: A total of 64 consecutive men (mean age 34.5 yrs) were enrolled in this study. Twenty-six underwent unilateral microsurgical subinguinal varicocelectomy, of which 23 were left and 3 right. The remaining 38 patients underwent bilateral varicocelectomy for a total of 102 varicocele units. Varicoceles were clinically graded I-III. Pre-operatively, 53 varicocele units had sonographic size available. At surgery, the diameter of the largest internal spermatic vein at the external inguinal ring was measured using a sterile micro-ruler prior to ligation. RESULTS: For clinical grade I varicoceles, the mean sonographic size (n⫽15) was 2.7 mm (⫾ 0.7), and the mean intra-operative size (n⫽20) was 3.5 mm (⫾ 0.9). For grade II varicoceles, the mean sonographic size (n⫽21) was 2.4 mm (⫾ 1.2), and the mean intra-operative size (n⫽42) was 3.7 mm (⫾ 0.9). For grade III varicoceles, the mean sonographic size (n⫽17) was 3.5 mm (⫾ 1.5), and the mean intra-operative size (n⫽40) was 5.2 mm (⫾ 1.6). Using analysis of variance (ANOVA) with Scheffe multiple comparison adjustment, clinical grade was predictive of intra-operative vein size (p⬍0.0001). Intra-operative vein size for grade III varicoceles was significantly larger than that of grades I and II varicoceles (p⬍0.0001). There was no significant difference in intra-operative size between grades I and II (p⫽0.78). Clinical grade was also predictive of sonographic vein size (p⫽0.03). However, this correlation was only significant between grades II and III varicoceles after post-hoc adjustment (p⫽0.03). There was no significant linear correlation between sonographic and intra-operative vein size (r2 ⫽ 0.12, p ⫽ 0.38). CONCLUSION: Clinical varicocele grade is predictive of intra-operative vein size. Clinical grade is also predictive of pre-operative sonographic varicocele size, although this difference is only significant between grades II and III varices. There was no significant correlation between pre-operative sonographic vein size and intra-operative vein size. Sonographic and
S374
Abstracts
OBJECTIVE: To compare time reduction, patency, and leak-resistance of tissue sealants to standard vasovasotomy suture techniques. DESIGN: The gold standard for performing a vasovasostomy is a layered microsurgical anastamosis. Fibrin glue has been used in previously published studies to reduce operative time while maintaining patency. A recent Medline search revealed no studies testing other tissue adhesives such as BioGlue or Dermabond. This study not only compared the operative time needed for suturing/gluing a prepared vas, but also tested the anastamosis for both patency and leakage. MATERIALS AND METHODS: Bull vasa were cut into 6 centimeter lengths and then divided in half to simulate a vasectomy. 4 vas segments used for each of the 5 anastamotic techniques. A dissecting microscope was used to assist with the following: (1) a 2-layer anastamosis consisted of 6 (10-0) mucosal sutures and 6 (9-0) muscularis sutures, (2) a modified 1-layer anastamosis consisted of 6 transmural sutures and 6 muscularis sutures (all 9-0), and (3) a glue reinforced anastamosis supported by 3 evenly spaced transmural (9-0) sutures. A stop-watch was used to time the placement of sutures and then glue application (applied circumferentially). For storage, the vasa were kept in normal saline at 36 degrees F. One vasal tip was gently dilated with a jeweler forcep to allow insertion of a 24 gauge angio-catheter. Saline was used verify anastamotic patency. Next, the opposing vasal end was occluded, and a Laveen syringe was used to test for anastamotic leakage. Finally, microscopy was performed to check for the presence of any glue within the vasal lumen. RESULTS: The mean operative time was greatest for the 2-layer anastamosis. The modified 1-layer technique took less time– but did not reach statistical significance . On the contrary, a significant time reduction was noted when glue was used to reinforce a 3-suture anastamosis. All anastamotic techniques were patent, and on microscopic analysis, none of the glue-reinforced specimens had contaminated the lumen. Regarding leak testing, BioGlue and Dermabond did better than both Fibrin glue and the 2 suture techniques. By grouping the 3 different glue techniques and the 2 different suture techniques, an exact logistic regression model was performed using an odds ratio of 95%. The odds of leaking were 1.6 times higher in the surgery group compared to the glued group. This difference, however, was not statistically significant (95% confidence interval for odds ratio [0.2, 15.7]; p-value ⫽ 0.93).
CONCLUSION: A glue reinforced vasovasostomy anastamosis is significantly less time-consuming than standard suture techniques. Additionally, BioGlue and Dermabond are much more leak-resistant than either Fibrin glue or the sutured techniques. Although previous research shows that Fibrin glue successfully reinforces vasovastomies, the results found in this study suggest that BioGlue or Dermabond may offer even better results. Supported by: None
Vol. 86, Suppl 2, September 2006