Name: clinical application of 24 g cannula needle and 3-0 polypropylene suture in vas deferens exploration
Uploaded: 2023-02-10T14:55:00
Description: Watch this Scientific Journal Video about Clinical Application of 24 G Cannula Needle and 3-0 Polypropylene Suture in Vas Deferens Exploration at JoVE.com

We thank ZHZ for the conception and design of the study. JW and YPZ performed and supervised the operation. YH, YBX, SL contributed to data analysis. JW and WJL prepared the draft of the video. All authors participated in the revision of the manuscript. All authors read and approved the final manuscript.

All methods described here were approved by the Ethics Committee of Union Hospital Tongji Medical College, Huazhong University of Science and Technology. We obtained the patient&#39;s consent to use his surgical footage as a video after the procedure.
1. Instruments for operation
<ol>
	<li>Ensure the availability of a surgical microscope system, microsurgical instrument, and microscopic bipolar electrocoagulation.</li>
</ol>
2. Preparation for o...

<ol>
	<li>Chen, X. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+features+and+therapeutic+strategies+of+obstructive+azoospermia+in+patients+treated+by+bilateral+inguinal+hernia+repair+in+childhood.">Clinical features and therapeutic strategies of obstructive azoospermia in patients treated by bilateral inguinal hernia repair in childhood.</a> Asian Journal of Andrology. 16 (5), 745-748 (2014).</li><li>Sparkman, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bilateral+exploration+in+inguinal+hernia+in+juvenile+patients.+Review+and+appraisal.">Bilateral exploration in inguinal hernia in juvenile patients. Review and appraisal.</a> Surgery. 51, 393-406 (1962).</li><li>Pollak, R., Nyhus, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+groin+hernia+repair.">Complications of groin hernia repair.</a> The Surgical Clinics of North America. 63 (6), 1363-1371 (1983).</li><li>Sheynkin, Y. R., Hendin, B. N., Schlegel, P. N., Goldstein, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microsurgical+repair+of+iatrogenic+injury+to+the+vas+deferens.">Microsurgical repair of iatrogenic injury to the vas deferens.</a> The Journal of Urology. 159 (1), 139-141 (1998).</li><li>Wang, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+for+Vas+Deferens+Obstruction+Following+Childhood+Herniorrhaphy.">Treatment for Vas Deferens Obstruction Following Childhood Herniorrhaphy.</a> Urology. 112 (1), 80-84 (2018).</li><li>Smith, R. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+significance+of+sperm+heads+and+tails+within+the+vasal+fluid+during+vasectomy+reversal.">The significance of sperm heads and tails within the vasal fluid during vasectomy reversal.</a> Indian Journal of Urology. 30 (2), 164-168 (2014).</li><li>Jungwirth, A., Diemer, T., Kopa, Z., Krausz, C., Tournaye, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=European+Association+of+Urology+guidelines+on+male+infertility.+2017+edition.">European Association of Urology guidelines on male infertility. 2017 edition.</a> , 23-24 (2017).</li><li>Bromage, S. J., Falconer, D. A., Lieberman, B. A., Sangar, V., Payne, S. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sperm+retrieval+rates+in+subgroups+of+primary+azoospermic+males.">Sperm retrieval rates in subgroups of primary azoospermic males.</a> European Urology. 51 (2), 539-540 (2007).</li><li>Du, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Differential+diagnosis+of+azoospermia+and+etiologic+classification+of+obstructive+azoospermia:+role+of+scrotal+and+transrectal+US.">Differential diagnosis of azoospermia and etiologic classification of obstructive azoospermia: role of scrotal and transrectal US.</a> Radiology. 256 (2), 493-503 (2010).</li><li>Pasqualotto, F. F., Pasqualotto, E. B., Agarwal, A., Thomas Jr, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Results+of+microsurgical+anastomosis+in+men+with+seminal+tract+obstruction+due+to+inguinal+herniorrhaphy.">Results of microsurgical anastomosis in men with seminal tract obstruction due to inguinal herniorrhaphy.</a> Revista do Hospital das Clinicas. 58 (6), 305-309 (2003).</li><li>Shaeer, O. K. Z., Shaeer, K. Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopy-assisted+pelvi-scrotal+vasovasostomy.">Laparoscopy-assisted pelvi-scrotal vasovasostomy.</a> Andrologia. 36 (5), 311-314 (2004).</li></ol>

As mentioned before, the location of the vas deferens stump cannot be determined at the inguinal incision, which requires exploration of the original inguinal incision. In this study, we can use this simple operation to determine the site of obstruction and make surgical decisions. If the site of obstruction is in the original incision, MVV can be considered. If the vas deferens injury is not found in the inguinal canal, we can use lapa-VV or SV.
When pasty fluid without sperm was found and th...

Microsurgical vasovasostomy (MVV) is a common treatment for vas deferens obstruction after herniorrhaphy in childhood1,2. The site of obstruction cannot be identified preoperatively, and it is not clear whether sperm are present in the vas deferens or not. This may lead to difficulty in selecting the incision and injury to the vas deferens during semi-open exploration, which decreases the success rate of anastomosis, prolongs the operation time, and increases the risk of abdominal exploration3,4. 
Injury to the vas deferens in the inguinal canal is likely an after-effect of inguinal hernia surgery in childhood, which can usually be caused by ligation, incision, or overstretching1. The rate of azoospermia after herniorrhaphy in childhood is approximately 0.8%-2.0% in pediatric patients. However, in the infertile population, the rate of iatrogenic obstruction is significantly increased, with a history of vas deferens injury in 7.2% of andrological procedures2,3. Surgical exploration of the inguinal region is usually performed to look for vas deferens remnants for anastomosis4. In previous cases, the ruptured end of the vas deferens is usually not found during inguinal exploration, which leads to the termination of the operation and increases surgical trauma to the patient. Therefore, it is very important to use a simple method to determine the location of the obstruction to clarify the following surgical procedures. 
In this study, a 24 G cannula was used to puncture the vas deferens to confirm the presence of sperm in it, and a 3-0 polypropylene suture was passed through the cannula to determine the location of the obstructed site. Based on this simple operation, we can determine the next surgical procedure. After practicing and summarizing the clinical operations, our specific surgical method is presented below.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>0.9% sodium chloride solution</td>
			<td>Guangdong Otsuka Pharmaceutical Co. LTD</td>
			<td>&#160;21M1204&#160;</td>
			<td>Inject into the vas deferens</td>
		</tr>
		<tr>
			<td>1% iodophor</td>
			<td>Guangzhou Qingfeng Disinfection Products Co., LTD&#160;</td>
			<td>Q/QFXD2</td>
			<td>Skin disinfection</td>
		</tr>
		<tr>
			<td>24G cannula needle</td>
			<td>Suzhou Linhua Medical Instrument Co., LTD</td>
			<td>20193141896</td>
			<td>Size:24G, Type:Pen type, with wings, with injection port, Y type</td>
		</tr>
		<tr>
			<td>3-0 monofilament polypropylene</td>
			<td>Covidien Medical Equipment international trading (Shanghai) Co., LTD</td>
			<td>DOL2861y</td>
			<td>Taper Point, Size 3-0, Blue, 36&#34;, Needle V-20, 1/2 Circle</td>
		</tr>
		<tr>
			<td>5 mL syringe</td>
			<td>&#160;Kindly Medical, Shanghai</td>
			<td>&#160;K20210826</td>
			<td>Inject 0.9% sodium chloride solution into the vas deferens</td>
		</tr>
		<tr>
			<td>F16 Catheter</td>
			<td>&#160;Guangzhou Weili Co., Ltd&#160;</td>
			<td>20190612</td>
			<td>Drainage of urine</td>
		</tr>
		<tr>
			<td>micro haemostatic forceps</td>
			<td>Shanghai Medical Instrument (Group) Co., LTD.</td>
			<td>W40350</td>
			<td>Used in surgical procedures</td>
		</tr>
		<tr>
			<td>micro scissors</td>
			<td>Shanghai Medical Instrument (Group) Co., LTD.</td>
			<td>WA1010</td>
			<td>Used in surgical procedures</td>
		</tr>
		<tr>
			<td>micro tweezers</td>
			<td>Shanghai Medical Instrument (Group) Co., LTD.</td>
			<td>WA1020</td>
			<td>Used in surgical procedures</td>
		</tr>
		<tr>
			<td>Olympus microscope</td>
			<td>Olympus Corporation</td>
			<td>Scipu001158</td>
			<td>4&#215;N.A.0.10 W.D.22.0mm&#160;&#160;&#160;&#160; 10&#215;N.A.0.25 W.D.10.5mm&#160;&#160;&#160;&#160;&#160;&#160; 40&#215;N.A.0.65 W.D.0.56mm&#160;&#160;&#160;&#160; 100&#215;N.A.1.25 W.D.0.13mm&#160;</td>
		</tr>
		<tr>
			<td>Operating microscope system</td>
			<td>&#160;Carl Zeiss Co., Ltd&#160;</td>
			<td>OPMI VARIO 700</td>
			<td></td>
		</tr>
	</tbody>
</table>

clinical application of 24 g cannula needle and 3-0 polypropylene suture in vas deferens exploration

The goal of this article is to present the application of a 24 G cannula and 3-0 polypropylene suture as a simple method for the exploration of the vas deferens. During the exploration of the vas deferens, a 24 G cannula needle was used to puncture it. The fluid in the smear confirmed the presence of sperm, to determine whether or not there was concomitant obstruction at the junction of the epididymis and the vas deferens. Then, a 3-0 polypropylene suture (this suture specification has the advantages of a smooth surface, robust quality, and can be passed through a 24 G cannula needle) was passed through the cannula needle to probe the location of the obstructed site. With this technique, exploration of the vas deferens could be more targeted and accurate.

There were 67 patients enrolled in the study. As shown in Table 1, the mean age of the patients was 28.8 &#177; 3.7 years (range: 23-45 years). The time since herniorrhaphy was 24.5 &#177; 3.2 years (range: 21-43 years). The female partners were 25.2 &#177; 3.2 years (range: 23-42 years) years old. A total of 11 (16.4%) patients had pain in the scrotum. Four patients (6.0%) were underweight (BMI &#60; 18.5 kg/m2), 53 (79.1%) had normal weight (BMI 18.5-24.9 kg/m2), eight (11.9%) wer...

Watch this Scientific Journal Video about Clinical Application of 24 G Cannula Needle and 3-0 Polypropylene Suture in Vas Deferens Exploration at JoVE.com

Clinical Application of 24 G Cannula Needle and 3-0 Polypropylene Suture in Vas Deferens Exploration

This protocol presents the clinical application of a 24 G cannula and 3-0 polypropylene suture as a simple and effective method for the exploration of the vas deferens.

The goal of this article is to present the application of a 24 G cannula and 3-0 polypropylene suture as a simple method for the exploration of the vas ...

Microsurgical vasovasostomy is a common treatment for vas deferens obstruction following childhood herniorrhaphy. It's difficult to predict the location of the obstructive site before surgical exploration and it's not clear whether there are sperms in vas deferens or not, this may cause the incision selection difficulty and the vas deferens injury by semi-open exploration which reduced the success rate of anastomosis, extend the time of surgery, and increasing the risk of abdominal exploration. In previous cases, the ruptured end of the vas deferens was usually not found during the inguinal exploration resulting in discontinuation of operation and increasing the patient's surgical trauma.Therefore, how to use the simple method to determine the site of the obstruction in order to clarify the following surgical procedures is very important. After the practice and the summary of clinical operation our specific operation measures are introduced as follows. Procedure of the surgery.After anesthesia, we performed standard disinfection with the patient in supine position. We made a three centimeter incision along the middle fold of the scrotum. Then we pierced one testicle and incised the flesh membrane to expose the testicular sheath and spermatic cord.We separated along the space between the vasculature of the vas deferens and vasculature of spermatic cord. Then we secured the vas deferens with the tissue forcep and prepared for our vesicocentesis. We inserted a 24G cannula needle diagonally down 15 degree along the longitudinal axis of the vas deferens, pulled out the needle core after obvious tactile breakthrough and pushed the softer trocar to the lumen.After identification of the vas deferens, two ml of normal saline was used to push in the 24G cannula needle, it confirmed the obstruction of the proximal vas deferens with the saline could not be pushed in. The liquid in the vas deferens smear test could confirm the presence of sperm to confirm whether or not there is a simultaneous obstruction at the junction of the vas deferens and epididymis. After that, 3-0 Prolene suture was passed through the cannula needle to probe the position of obstructed site.Our study grouped the site of obstruction into three groups. Number one, the vas deferens obstruction is located at the incision of original hernia repair. Number two, the vas deferens obstruction positions two centimeter higher than the original incision.Number three, the vas deferens obstruction is over five centimeter from the upper edge original incision. This technology could make the exploration of the vas deferens more purposefully and accurately. Representative results.A total of 67 patients were enrolled in the study. As shown in table one, patients age ranged from 23 to 45 years. The time since herniorrhaphy was ranging from 21 to 43 years.The mean age of the female partners was ranging from 23 to 42 years. 11 patients had scrotal pain. Four patients were underweight, 53 were normal, eight were overweight, and two were obese.The site of the vas deferens obstruction and results in the different subgroup based on operative styles is shown in table two. The smear test showed that no sperm are present in the cannula needle liquid in 25 cases, of these, three underwent bilateral VV in which the obstruction site is located in the original incision and the patency rates were 33.3%22 underwent ART, in which the vas deferens obstruction positions two centimeter higher than the upper edge of original incision. The smear test establishes that sperm exists in the cannula needle liquid in 42 cases, of these, 29 underwent bilateral VV in which the obstruction site is located in the original incision and the patency rates were 79.3%Then underwent Lapa-VV in which the obstruction site positions two centimeter higher than the original incision and the patency rates were 40%Three underwent SV in which the obstruction site position five centimeter higher than the original incision and the patency rates were 33.3%Conclusion and discussion.In our study, there are several possibilities during the exploration. Number one, if a smear test establishes that no sperm is present in the cannula needle liquid, there may be a simultaneous obstruction at the junction of the vas deferens and the epididymis. If the vas deferens obstruction positions two centimeter higher than the upper edge of original incision, which is probed by the Prolene suture, it can be considered to undergo the assisted reproductive technology directly.If the obstruction site is located in the original incision, it can be considered to undergo MVE MVV. Number two, if a smear test establishes that sperm exists in the cannula needle liquid, while 3-0 Prolene suture detection of obstruction is located at the incision of original hernia repair, the original inguinal incision can be explored directly. Number three, if a smear test establishes that sperm exists in the cannula needle liquid while 3-0 Prolene suture detection of obstruction is within two centimeter from the upper edge original incision, laparoscopy-assisted vas deferens exploration can be considered and the proximal vas deferens can be pulled out from the external inguinal annulus for anastomosis.Number four, if a smear test establishes that sperm exists in the cannula needle liquid while 3-0 Prolene suture detection of obstruction is over five centimeter from the upper edge original incision, there may be a seminal vesicle dysplasia or ejaculatory duct obstruction. Combined with the preoperative semen volume and seminal vesicle MRI, seminal vesicle endoscopy exploration could be considered. The simple operation of 24G cannula needle and 3-0 Prolene suture has little injury of the vas deferens, optimizes the surgical procedure, increase the intensity of surgical-decision making, and provides a simple and effective method for maximizing the interest of patient.

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