Local anesthetic, regional anesthetic (i.e., a spinal block) or general anesthetic can be used.

A general anesthetic may be required to provide best results. This is because during the surgery it may be required to extend surgical incisions up into the abdomen to free up greater length of the vasa should the surgeon encounter difficulties during the surgery. This may be more difficult to do under local anesthetic.

Regional anesthetic, i.e., a spinal block, where the anesthetic solutions is injected into the spine while the patient remains conscious, is also a good option. Operating times can vary between two to three hours and/or up to five or more hours depending on what the surgeon encounters during the procedure.

Surgery is performed first on one side of the scrotum and then on the other.

It is imperative that the surgeon be skilled enough and experienced enough to perform either the vasovasotomy or vasoepididymostomy procedure. Both procedures begin the same way.

The surgeon will identify the right and left vas tubes. He will then make incisions, beginning at the top of the scrotum extending up into the abdomen a number of inches on both the right and left side.

Once the tissue is cleared off the first vas tube, the surgeon must make a decision regarding what will be required to re-establish sperm flow, a vasovasotomy or a vasoepididymostomy. He makes his decision after opening up the testicular end of the blocked vas and checking the fluid from that blocked end.

Evaluation of this fluid is a key step in deciding which avenue to take for vasectomy reversal.

If sperm are present in this fluid, which will be determined by a quick microscopic examination, then the more simple vasovasotomy will likely suffice in re-establishing sperm flow.

Diagram:
a) two cut and blocked vas deferens.
b) finished vasovasostomy - vas deferens are reconnected.

However, if sperm are absent and there is only a thick white water-insoluble toothpaste-like fluid, it is unlikely that sperm will be found and a vasoepididymostomy is needed.

Diagram:
a) vas deferens are connected to the epididymis.
b) completed vasoepididymostomy.

On the other hand, if no sperm are found even though the vas fluid is copius, crystal clear and watery, a vasovasostomy can still be performed because there is a high likelihood that with this type of fluid sperm flow will still be re-established.

If there is no fluid at all, in addition to no sperm, it is unlikely that a vasovasotomy would work and a vasoepididymostomy likely would be indicated.

When the surgeon sets out to reconnect the vas, to either the other cut end or the epididymis, surgeons differ on their approach to reconnection.

Some prefer a single layer microscopic closure. This requires less time but can be less accurate in bringing the ends together.

Other surgeons will perform a double layer microscopic reversal. This involves placing approximately eight sutures through the inner portion of the tube.

Then, before pulling them tight, placing a second series of sutures along the outer surface of the two cut ends of the tubes. Then the inner portion is tightened and closed, followed by the outer layers.