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.
Fig. 26.10. RAVV anterior muscular anastomosis (From Brahmbhatt et al. [ 3 ],
with kind permission Springer Science + Business Media).
the epididymis. The adventitial layer of the epididymis is incised above
the level of epididymal obstruction (blue/gray zone with dilated epididymal
tubules above this area). A 3-0 Prolene suture is used to attach the
testicle to the adventitia of the vas to prevent tension between the anastomosis.
The vas is stripped off the adventitia and flipped toward the
epididymal tubules. The robot is now positioned similar to above. Two
10-0 nylon double-armed suture needles are placed longitudinally
through a single epididymal tubule to expose the tubule. This tubule is
then incised longitudinally using the micro-Potts scissors between the
two suture needles to create a lumen in the tubule. The fluid is then
aspirated and examined under a separate phase contrast microscope for
the presence of sperm.
When sperm is confirmed, two double-armed 10-0 nylon needles in
the epididymal tubule are advanced through, and then all four of the
needles are brought inside out on the vas mucosal lumen to involute the
epididymal tubule lumen into the vas lumen (Fig. 26.11 ) [ 3 ]. Five to six
9-0 nylon sutures are placed circumferentially to approximate the muscularis
of the vas to the adventitia of the epididymal tubule (Fig. 26.12 )
[ 3 ]. The testicle and anastomosis are carefully delivered back into the
scrotum. The dartos layer and skin are closed .