Microsurgery

	Prior to the use of the operative microscope, vasectomy reversals had a dismal success rate. The lumen represents a very small portion of the vas deferens, and lining the two lumens of each side without magnification was left to luck. With the microscope, we can now use extremely fine suture to precisely align the two ends attaching lumen to lumen. The Procedure The typical vasectomy reversal is called a vasovasostomy. This entails dissecting the old vasectomy site, removing the scarred portion and checking both ends. The testicular ends should have fluid expressed and observed under a microscope (more powerful than the operative microscope) looking for sperm. If sperm are present or the fluid expressed is consistent with eventual sperm presence, this end of the vas deferens can be used. The abdominal or remaining side is inspected and confirmed to be patent with the urinary tract by either injecting fluid or running a suture through the lumen. If a blockage is present, further exploration as to the cause of obstruction should be made. If all is well, the two ends are then placed in proximity to each other and re-attachment proceeds. The use of extremely fine suture material. and the operative microscope permit re-attachment in a precise fashion. The Day of the Procedure After midnight the evening before surgery, no food or drink can be taken. You should be at the hospital 60 to 90 minutes before the scheduled operation time to let the anesthesiologist perform a pre-operative check. After general anesthesia is given, you will be asleep for three to five hours depending on the type of reconstruction necessary. The presence of sperm or quality of fluid in the vas deferens determines the level of reconstruction. Unfortunately, it is impossible to determine whether a vasovasostomy or vasoepididyostomy will be required from simply examining a patient. One incision for each side is performed and after the microscopic repair is complete, the wound is closed with stitches that will absorb. Once completely awake, you will be discharged with prescriptions for an antibiotic and pain medication. Ice should be placed on the wounds for the rest of the day of the procedure. Light work can be resumed after one week, but heavy lifting or straining should be avoided for two weeks. Post operative semen analysis will be performed after 2 to 3 months.

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