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
VasectomyMedical.com
very much appreciates the opportunity to provide readers the opportunity to learn
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