Vasectomy reversal: Microsurgical epididymovasostomy (two-suture intussusception)

Section Editor’s note: ‘Y’tube, a new video section of UrologyTimes.com, is a resource for urologists and other clinicians who focus on men’s health. ‘Y’tube covers surgical aspects of a variety of men’s health issues with the ultimate goal of accumulating a library of videos to serve as a reference. 

A microsurgical epididymovasostomy is performed when no sperm are found in the testicular end of the vas deferens at the time of microsurgical reconstruction. If a standard vasectomy reversal (vasovasostomy) is performed in this setting, sperm will not return to the semen, and the vasectomy reversal will fail. Therefore, the microsurgeon must be prepared to do either reconstructive technique. The complex microsurgical vasectomy reversal with epididymovasostomy requires specific microsurgical training and skills. This video demonstrates the two-suture intussusception technique for microsurgical epididymovasostomy.

Dr. Hotaling: Dr. Williams employs many of the key steps to optimizing an epididymovasostomy. Specifically, he has dissected out one individual epididymal tubule and freed up the vas deferens in order to ensure a tension free anastomosis. He has then pre-placed two 10-0 nylon sutures in the epididymal tubule between a small slit-like opening in the tubule. He then secures the vas to the epididymal tunic with 9-0 nylon sutures. The pre-placed 10-0 nylon sutures are then brought from the lumen to the serosa of the vas.

Once these two sutures are each secured from in to out on the vas with either end of the double-armed suture, they are tied down, parachuting the open epididymal tubule into the vas deferens.

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