Vasectomy reversal surgery
Microsurgical vasectomy reversal using a high-powered surgical microscope and microsurgical instruments is superior to operating without a microscope. Microsurgical techniques enable optimal visualisation of the vas deferens allowing accurate and precise placement of each suture. Using a multi-layered technique of extremely fine sutures provides better results than older less precise methods.
Expertise and experience matter
You will have a general anaesthetic for your operation.
Two incisions of about 2.5cm are made on either side of the scrotum above the testes. These permit access to the vasectomy sites.
The site of the vasectomy is identified. The amount of vas deferens which is absent or damaged is assessed. Occasionally so much vas deferens has been damaged that it is necessary to consider the surgical technique called microsurgical vaso-epididymostomy. Extremely rarely the upper part of the vasectomy site is too high in the groin to allow reversal on that side.
Dissection of the vas deferens
The vas deferens is then dissected free of the surrounding tissue, back to normal vas deferens above and below the vasectomy site. Having dissected the vas deferens free, it is precisely cut on either side of the vasectomy site so that normal open tube is available for reanastomosis bypassing the vasectomy site.
In the most common method known as vaso-vasostomy the cut ends of the vas deferens are brought into close proximity with each other and stabilised by a small non-traumatic clip. An operating microscope is used to magnify the site approximately 40 times. A series of very fine microscopic sutures (much finer than a human hair) are placed around the circumference of the lumen of the vas deferens (which is less than the diameter of a pin) to bring the ends together and establish patency. A second layer of sutures is then added to provide support and stability to the site of the anastomosis.
Video of vasectomy reversal
This is a video of Dr Woolcott performing the microsurgical component of a vaso-vasostomy procedure for vasectomy reversal. Initially, you can see the two prepared ends of the vas deferens. Prior to this point in the operation, incisions have been made on either side of the site of the previous vasectomy, the cut ends have then been positioned in a small clasp holding them very close together.
The operation then proceeds with a series of circumferential microscopic stitches through the muscle and then lumen (the tube) of the vas deferens on one side and out through the opposing side. These stitches slowly bring the two opposing lumens together to re-establish a patent (open) vas deferens. Just prior to the final closing stitch particular attention is paid to ensure the vas deferens is open. Following this part of the microsurgical vasectomy reversal a second (and when required third) layer of fine stitches is placed to support the anastomosis of the vas deferens and complete the operation.
Should it not be possible to re-connect vas deferens to vas deferens due to extensive damage (vaso-vasostomy), vaso-epididymostomy will be performed connecting the vas deferens to the epididymis (which is the extremely fine tube between testis and vas deferens).
Once the microsurgery is finished the scrotum is closed in two layers: the first an inner continuous suture to bring the tissues together, and then the skin edges are closed by a very fine stitch just beneath the skin. The incision is the covered in surgical glue.