Robot-assisted vasectomy reversal
Epublication WebSurg.com, Jul 2014;14(07). URL: http://websurg.com/doi/lt03endeboccard001
Robot-assisted surgery developed faster and earlier in urology as compared to other fields of surgery. As some microsurgical procedures are applicable to this field, the evolution towards robot-assisted microsurgery was a logical extension. We started our vasectomy reversal program as early as 2003 and completely left the traditional microscope aside. Microsurgical techniques must be mastered first. The lack of haptic feedback must then be compensated with the robot by means of optical vision of the tension applied on the thread. In addition, the force applied on the manipulators must be controlled with gentle pressure in order to prevent mashing and cutting of the threads or bending of the needles. The pressure of the jaws of the forceps is less intense at the tip, and only that part of the instrument should be used. Our results on 19 robot-assisted vasectomy reversal (RAVV) procedures demonstrate a 92% patency rate. We present two videos. The first video describes a two-plane vasectomy reversal with 11/0 and 10/0 sutures. The second one presents a modified two-plane vasectomy reversal with 10/0 and 9/0 sutures. We use two black diamond micro-forceps and Potts scissors. The use of the fourth arm shortens the procedure, precluding the need to change instruments or the help of an assistant. Robotic microsurgery offers a better outcome with a more stable operative field, more precise movements without tremor and better ergonomics for the surgeon, hence reducing the operative time.