Vasectomy Reversal: The basics

 

Vasectomy. The tube that runs from the testes to the urethra in the penis is called the Vas Deferens. It is a muscular tube that sperm travel along after being produced in the testes. During ejaculation the tubes forces sperm into the urethra tube in the penis and then sperm is deposited in the female vagina to start the process of potentially fertilising a female egg. A vasectomy is the operation to tie off the tube therefore blocking it and creating a contraceptive method, so no sperm is deposited during sex. There are multiple methods but most just snip the Vas then tie it off.

Microsurgery. The procedure to reverse a vasectomy is done using a high- powered surgical microscope and microsurgical fine instruments needed to work with the fine sutures used.

The male is booked in for surgery, given a date and all administrative procedures finalised. He fasts before the surgery and some men shave their scotum prior to surgery.

The male patient is positioned on the surgical table then a general anaesthetic is given. This is vital as the patient must not move during the procedure at all. The right and left vasectomy position is identified then the area is opened to find the site where the vas deferens tube was ligated (cut).

The vas ends are redefined by a scalpel cut to give two clean ends to bring together known as re-anastomosis.  When all is lined up the microscope is brought in and the really interesting part starts.

The basic surgical approach is to suture together the two vas ends. Prior to this the tubes are flushed with a fine syringe. That confirms they’re open or patent. Some surgeons test the fluid for sperm (we do not?)

Fine sutures as thin or thinner than a human hair is used, and each surgeon has their own techniques long established. The thinnest sutures called 8.0 (pronounced “eight-O”) are the main ones used. Thicker outer layers suture of 6.0 provide support and reduce tension on the fine 8.0 sutures once the anastomosis is complete with between 3-5 fine 8.0 sutures of a nylon permanent suture.

Both sides are anastomosed (joined) in the majority of cases. Sometimes only one can by done for surgical reasons. Perhaps the vasectomy position is too damaged to repair, or one end has retracted too far to safely attach in a tension free manner. Sometimes there are too many veins close by. In the vast majority of men both sides are able to be repaired.

Surgical techniques for microsurgery are well established.

  • Meticulous technique
  • Fine sutures are used, in our case 8.0 nylon which is permanent.

  • The avoidance of bleeding so a dry surgical field at the end.

  • No foreign bodies i.e., no bits of suture, talcum powder from gloves left.

  • Perfect apposition of the ends of the vas.

  • Minimal tissue trauma so careful handling of delicate tissues to reduce damage
  • Maintaining excellent blood supply to the surgical repair site, the anastomosis
  • Avoid smoking. This can impact the healing process significantly so stop smoking before surgery.

  • Experience. Its hard to express in a website but a surgeon having many years of experience gives a patience confidence they have done this before. Jeffrey, Frank and David have this experience.

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