Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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J.V. Brahmbhatt et al.
Vasectomy Reversal for Post Vasectomy Pain
Introduction
Vasectomy is a common form of contraception. An estimated 40–60
million men worldwide rely on this method of contraception [ 22 ].
Complications after vasectomy are rare, but 10–15 % of men may suffer
from chronic post vasectomy testicular and groin pain. Congestive epididymitis
is one possible mechanism for the chronic discomfort, and
therefore, vasectomy reversal is a viable treatment option [ 19 , 23 ].
Between July 2007 and March 2013, 147 robotic-assisted vasectomy
reversals were performed by two fellowship trained microsurgeons. There
were 90 robotic-assisted microsurgical vasovasostomy (RAVV) procedures
and 57 robotic- assisted microsurgical vasoepididymostomy (RAVE)
procedures performed. Twenty of these patients had chronic scrotal pain
after vasectomy, and the rest wished to regain fertility. Median patient age
was 42 years, and median duration from vasectomy 7 years for RAVV and
11 years for RAVE. Median OR setup duration was 30 min, and median
robotic OR duration was 120 min and 150 min for RAVV and RAVE,
respectively. After 23 months median follow-up, patency rates (>1 million
sperm/ejaculate) were 97 % in the RAVV group and 60 % in the RAVE
group. Pain relief occurred in 88 % of the patients who underwent RAVV
or RAVE for chronic scrotal pain related to vasectomy.
Technique in Detail: Robotic-Assisted Microsurgical
Vasovasostomy
The proximal and distal vas deferens (beyond the previous vasectomy
site) is palpated through the scrotal skin. Through the skin, the
distal vas is fixed into place with a towel clip. Local anesthetic is infiltrated
into this area. A 1–2 cm vertical incision is made over the vas,
starting inferiorly from the previously placed towel clip. Using fine
electrocautery and sharp dissection, the distal and proximal ends of the
vas are dissected free. The distal vas is dissected to allow a tension-free
anastomosis to the proximal vas. The proximal vas is carefully transected
with a No. 11 blade. Microscopic examination of the proximal
vas fluid is performed. If no sperm is present in this proximal fluid,
RAVE is performed. If sperm is found, then RAVV is performed. The
adventitia from either end of the vasa is now secured together with a 3-0
Prolene suture to allow a tension-free anastomosis.