Vasectomy Reversal: The Microdot Method
Posted by Mike Malone | Posted in Uncategorized | Posted on 28-06-2010-05-2008
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Although the number of American men who undergo vasectomy has stabilized at about 500,000 annually, the number requesting surgical reversal has grown dramatically. Estimates indicate that 2 to 6 percent of vasectomized men ultimately seek reversal.
In the United States, divorce with subsequent remarriage is by far the most common reason given for requesting reversal. In developing countries, the death of a child is the most common reason. In Bangladesh, for example, 5 percent of all couples who choose sterilization experience the death of a child within 1 year after operation. Before the refinement of microsurgical techniques, results of vasectomy reversal were relatively poor, with pregnancy rates varying from 5 to 30 percent.
The technical problems inherent in creating an accurate, leakproof anastomosis of structures with a luminal diameter of only 0.3mm are formidable. Microsurgical techniques of reversal now result in return of sperm to the ejaculate in over 90 percent of men and yield pregnancy rates in the patient’s partner of better than 50 percent.
It was developed a microsurgical three-layer technique of vasovasostomy that facilitates precision suture placement. The technique involves mapping of the planned suture exit points with “microdots” placed on the cut ends of the vas deferens with a microtip marking pen. Microdots are placed at 12, 3, 6 and 9. o’clock position. Four additional dots are placed between each of the previous 4 dots. Exactly 8 mucosal sutures (double armed 10-zero monofilament sutures) are used for each anastomosis (Figure 1, 2). The anastomosis is completed with 8 muscularis sutures (9-zero monofilament) and 6 to 8 sutures ( 6-zero monofilament) approximating the vasal sheath
