Microdot Technique Vasovasostomy
The Microdot method for performing vasectomy reversal is a variation of the standard multi-layer reverse vasectomy procedure. Similar 10-0 Nylon and 9-0 Nylon sutures to microsurgical vasovasostomy are used to re-approximate both layers of the vas deferens.
The microdot technique allows for easy placement of the mucosal 10-0 Nylon sutures. The microdots guarantee even placement of the mucosal sutures. Re-alignment of the vas deferens is performed during the reverse vasectomy procedure to ensure patency of the lumen of the vas deferens and to prevent long-term scarring of the vasectomy reversal procedure.
Once the inner luminal sutures are tied, the knots are cut precisely. Because of the very small size of the vas deferens lumen, any redundant suture material can obstruct the flow of sperm along the vas deferens. Likewise, sperm leakage outside of the lumen can cause obstruction of the vas deferens. A water tight closure of the vas deferens mucosa prevents sperm from leaking out of the vas deferens after the procedure.
The outer serosal sutures are equally important in the reverse vasectomy procedure. These sutures relieve tension off of the finer inner luminal sutures and prevent the ends of the vas deferens from separating after the reverse vasectomy procedure. Liberal placement of these outer serosal micro-sutures needs to be done under a microscope as well to ensure that the ends of the vas deferens are precisely approximated.
Epididymovasostomy (LIVE – Longitudinal Intussuception VasoEpididymostomy Technique)
In those cases where sperm are NOT identified in the testicular vas deferens, an epididymovasostomy or “bypass” operation is required. The typical appearance of the epididymis many years after the vasectomy procedure.
A single tubule from the epididymis is isolated for the reverse vasectomy procedure. This procedure can only be accomplished under the highest magnification and the patient laying completely still under a general anesthetic. Two microsurgical 10-0 Nylon sutures are passed through the single epididymal tubule along the longitudinal axis of the epididymal tubule, prior to opening the tubule.
The abdominal end of the vas deferens is re-approximated to the serosal edge of the tunic of the epididymis. The attachment of the vas deferens to the tunic of the epididymis secures the vas deferens and allows for accurate placement of the inner mucosal sutures.
The microsurgical 10-0 Nylon sutures are passed through the mucosa of the vas deferens in their corresponding locations on the mucosa of the vas deferens.
The 10-0 Nylon sutures are tied creating a water-tight closure between the epididymal tubule and the mucosa of the vas deferens. The single epididymal tubule is pulled (intussucepted) into the lumen of the vas deferens.
Additional microsurgical sutures are placed between the tunic of the epididymis and the outer (serosal) edge of the vas deferens. The additional microsutures on the outer layer of the vas deferens relieve the tension off of the important inner luminal sutures.
The final appearance of the vas deferens attached to the epididymis at slightly lower magnification. The “bypass” procedure restores continuity of sperm flowing through the vas deferens when an obstruction or “blockage” is identified at some part of the epididymis.
Vasectomy Reversal Recovery, Healing and Pictures of Incisions
Patients always wonder what the recovery process is after a vasectomy reversal and what their incisions should look like after surgery. Fortunately, our vasectomy reversal procedure is not a very extensive operation regardless of which of the two surgeries are Patients always wonder what the recovery process is after a vasectomy reversal and what their incisions should look like after surgery. Fortunately, vasectomy reversal is not a very extensive operation regardless of which of the two surgeries are not getting on a plane for 3-4 hours or sitting in the car for an equal amount of time was not a problem as soon as the day after performed. The amount of time required for surgery and the need for general anesthesia should make patients think that surgery.
Your restrictions for activity after a vasectomy reversal are designed more for the actual healing process that is on-going inside the scrotum, than the actual discomfort a patient feels. The tiny microscopic sutures are all that is holding everything together after the vasectomy reversal and it is imperative that these sutures are not disrupted while allowing the surgical site to heal. There is no good medical justification to tell patients to “take it easy” for 2, 3, 4, or 6 weeks. These restrictions are quite arbitrary and usually based on a vasectomy reversal specialist’s own experience with the healing process. We feel that patients are able to resume all of their physical activities 2-3 weeks after surgery based on our surgical technique at the Healthy-Male Vasectomy & Reversal Center in Mountain View and Los Gatos.
The typical appearance of the scrotum 1 week after vasectomy reversal surgery. The vasectomy reversal recovery shows minimal if any swelling and bruising in the scrotum. The scrotal rugae or “wrinkles” are apparent and indicative of resolution.
Close inspection of the right wound reveals some scab formation on the incision line. The scab can liquefy and cause some staining on the scrotal support, gauze or underpants.
The left side has virtually no swelling or bruising. The incisions are both approximately one inch in length. Compared to the previous vasectomy incisions/scars, the wounds are bigger. Both incisions are in the spectrum of normal healing 1 week after the vasectomy reversal.