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Mini-Incision Vasectomy Reversal Adopting the Principles of the No-Scalpel Vasectomy.

The “mini incision” microsurgical vasectomy reversal is an innovative surgical procedure that applies the no-scalpel vasectomy principles and instruments. The entire vasectomy reversal operation is performed using incisions that are less than 1 cm resulting in less post-operative pain and functional quicker recovery compared to a traditional vasectomy reversal.

As in the no-scalpel vasectomy, the mini-incision microsurgical vasectomy reversal begins by manipulating and stabilizing the vas directly under the scrotal skin using the “three finger technique.” The no-scalpel vasectomy ring clamp is then used to capture the vas through the scrotal skin at the site of the vasectomy so not to injure the vas itself. A small (< 1cm) opening in the scrotal skin is created and the vas is gently exposed, released and delivered out through the small opening in the skin. Despite the small size of the incision, the scrotal skin is compliant and flexible. It is important not to dissect too close to the vas in order to preserve a healthy blood supply around the vas and minimize scarring following the procedure. After the vas has been well mobilized, small windows on each side of the vasectomy occlusion site (abdominal and testicular ends) are created. To prevent the ends of the vas from slipping back inside the skin, fine holding stitches are placed through the outer muscular layer of the vas. The vas is then precisely cut at a healthy segment with a specialized surgical knife. The fluid within the vas leading to the testicle is analyzed to confirm the presence of sperm. If evidence of sperm is confirmed, a direct vas to vas reconnection (vasovasostomy) can be completed in a manner that the surgeon is most comfortable in performing. We use a 2-layer microsurgical technique using sutures that are finer than a human hair and a vas approximator to stabilize the ends of the vas during the reconnection. In our experience, sperm should return to the ejaculate in over 95% of cases. Upon of completion of the microsurgical reconnection, the vas is gently delivered back inside the scrotum. The small hole in the scrotal skin is closed with a single dissolvable suture which is then covered with a small band-aid. The vas on the second side is then be reconnected using the very same no-scalpel vasectomy principles and mini-incision technique. We have observed that by minimizing surgical dissection around the vas and testicle, this decreases operative times, results in less post-operative inflammation and pain, allows for quicker return to normal activities and accelerated return of healthy sperm to the ejaculate. This simple innovative technique can easily be adopted by urologists’ familiar the no-scalpel vasectomy technique.

This technique was been published in the medical journal Urology in October 2008. Please view the detailed video of the mini-incision vasectomy reversal using no-scalpel vasectomy principles and instruments.

Article Source:
With appreciation, this article has been written and submitted by:

Dr. Ethan D. Grober
Assistant Professor – University of Toronto
Division of Urology
Mount Sinai and Women’s College Hospital
www.vasectomyreversals.ca

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