In-office andrology: Videos show office-based hydrocelectomy, vasectomy reversal

These videos illustrate an efficient and cost-effective way to perform simple and complex andrology procedures without the need for an anesthesiologist. Landon W. Trost, MD, uses local anesthesia with liposomal bupivicaine (Exparel) to perform a hydrocelectomy and, in another patient, a vasovasostomy. As OR time is one of the most precious commodities in the health care system, these techniques demonstrate a very simple way to do these procedures without the need for general anesthesia. Infertility, which is typically not covered in most states, is an area where all the costs of the procedure are passed on directly to the patient, leading to a very cost sensitive environment.

-James M. Hotaling, MD, MS, Section Editor

Commentary on the videos is provided by 'Y'tube Section Editor James M. Hotaling, MD, MS, assistant professor of surgery (urology) at the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City.

Continue to the next page to watch the videos.

Hydrocelectomy using a minimally invasive, office-based approach - Landon W. Trost, MD
 

The current video presents a demonstration of an office-based, minimally-invasive hydrocelectomy technique performed under local anesthesia.  Descriptions are provided on methods to assure complete anesthesia, and outcomes of an initial series are provided.

Dr. Hotaling: Performing hydrocelectomy under local, while relatively common in other countries, is not routinely done in North American institutions. While most urologists would not necessarily be comfortable performing this under local, this technique provides a simple description of how this can be easily accomplished. Dr. Trost illustrates how it is vital to control the edges of the tunica vaginalis, which can easily slip back into the small incision and lead to bleeding.

Office-based vasectomy reversal using local anesthesia - Landon W. Trost, MD

The current video demonstrates an office-based approach for vasectomy reversal using only local anesthesia. Although office-based vasovasostomies have been previously performed in the office, the current video represents the first known description of an office-based epididymovasostomy under local anesthesia. Descriptions are provided on methods to optimize local pain control, and published outcomes of an initial series are presented. 

Dr. Hotaling: Dr. Trost shows how effective a good block can be, using Exparel he performs a local block as well as a cord block. He then identifies and delivers the vas, places a vessel loop around it, and uses blunt dissection to obtain 2 cm of length both proximally and distally, freeing up a remarkable amount of vas for the anastomosis through a small midline incision. He also illustrates an interesting technique of using snaps and a drain to provide a secure operative platform.  

Dr. Hotaling is assistant professor of surgery (urology) at the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City.

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