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V52 Robotic assisted microsurgical vasectomy reversal
V52
Robotic assisted microsurgical vasectomy reversal Eur Urol Suppl 2013;12;eV52
Brahmbhatt J., Gudeloglu A., Priola K., Parekattil S. University of Florida and Winter Haven Hospital, Dept. of Urology, Winter Haven, United States of America INTRODUCTION & OBJECTIVES: Microsurgical vasectomy reversal is a technically demanding procedure. Previous studies have shown possible benefits in the use of robotic assistance during such procedures. In this video we illustrate the video technique of robotic assisted microsurgical vasovasostomy (RAVV) and vasoepididymostomy (RAVE). MATERIAL & METHODS: A total of 132 men underwent RAVV/RAVE procedures between August 2007 and October 2012. A five-arm RMDSC technique was developed utilizing the daVinci Si robot (Intuitive Surgical, Sunnyvale, USA) with a dual 16-18x optical high magnification view (VITOM, Karl Storz Inc, Tuttlingen, Germany). For RAVV, 10-0 and 9-0 nylon sutures were used for the vasal mucosal and muscularis anastomosis, respectively. For RAVE, a longitudinal intussusception technique was performed with 10-0 double-armed nylon sutures. 9-0 nylon sutures were utilized for the vasal muscularis to epididymal tunica anastomosis. Semen analysis was obtained at 2, 5, 9 and 12 months postoperatively. RESULTS: The median patient age was 42 years for both RAVV and RAVE groups (23-64). Median follow-up was 21 months (1-47). 79 men underwent bilateral RAVV and 53 men underwent RAVE on one or both sides. Median duration from vasectomy was 8 years (1-23) for RAVV and 10 years (1-28) for RAVE. 16 cases were redo-vasectomy reversal procedures (men who had failed a previous microsurgical reversal elsewhere). Patency rate (>1 million motile sperm/ejaculate) was 96% in the RAVV cases and 60% in the RAVE cases. Median robotic microsurgical operative duration was 90 min for RAVV, and 120 min for RAVE. CONCLUSIONS: The outcomes of robotic assisted microsurgical vasovasostomy and vasoepididymostomy appear promising. Further evaluation and longer follow up is needed to assess its clinical potential and the true cost-benefit ratio.
Robotic assisted microsurgical vasectomy reversal Eur Urol Suppl 2013;12;eV52
Brahmbhatt J., Gudeloglu A., Priola K., Parekattil S. University of Florida and Winter Haven Hospital, Dept. of Urology, Winter Haven, United States of America INTRODUCTION & OBJECTIVES: Microsurgical vasectomy reversal is a technically demanding procedure. Previous studies have shown possible benefits in the use of robotic assistance during such procedures. In this video we illustrate the video technique of robotic assisted microsurgical vasovasostomy (RAVV) and vasoepididymostomy (RAVE). MATERIAL & METHODS: A total of 132 men underwent RAVV/RAVE procedures between August 2007 and October 2012. A five-arm RMDSC technique was developed utilizing the daVinci Si robot (Intuitive Surgical, Sunnyvale, USA) with a dual 16-18x optical high magnification view (VITOM, Karl Storz Inc, Tuttlingen, Germany). For RAVV, 10-0 and 9-0 nylon sutures were used for the vasal mucosal and muscularis anastomosis, respectively. For RAVE, a longitudinal intussusception technique was performed with 10-0 double-armed nylon sutures. 9-0 nylon sutures were utilized for the vasal muscularis to epididymal tunica anastomosis. Semen analysis was obtained at 2, 5, 9 and 12 months postoperatively. RESULTS: The median patient age was 42 years for both RAVV and RAVE groups (23-64). Median follow-up was 21 months (1-47). 79 men underwent bilateral RAVV and 53 men underwent RAVE on one or both sides. Median duration from vasectomy was 8 years (1-23) for RAVV and 10 years (1-28) for RAVE. 16 cases were redo-vasectomy reversal procedures (men who had failed a previous microsurgical reversal elsewhere). Patency rate (>1 million motile sperm/ejaculate) was 96% in the RAVV cases and 60% in the RAVE cases. Median robotic microsurgical operative duration was 90 min for RAVV, and 120 min for RAVE. CONCLUSIONS: The outcomes of robotic assisted microsurgical vasovasostomy and vasoepididymostomy appear promising. Further evaluation and longer follow up is needed to assess its clinical potential and the true cost-benefit ratio.