A Modified Vessel-Sparing Microsurgical Vasoepididymostomy

Summary

Here, we present a protocol to preserve the vasal vessels in microsurgical vasoepididymostomy. The surgical security is enhanced by preserving the vasal vessels using a retrograde-anterograde dissociation and fixing the vasal vessels.

Abstract

Microsurgical vasoepididymostomy (MVE) is the main surgical treatment for epididymal obstruction. The vasal vessels are ligated during MVE. However, preserving the vasal vessels during MVE might better simulate the normal physiological structure and be meaningful for patients who have undergone varicocelectomy. Nevertheless, preserving the vasal vessels might elevate the risk of increasing the tension of anastomosis, affecting the patency rate and leading to delayed postoperative bleeding. Therefore, we developed a novel vessel-sparing MVE to make it safer. Here is a summary of the improvements to the procedure. 1) The retrograde dissociation of the vasal vessels on the proximal testicular side was adopted as the main method, and the anterograde dissociation of the vasal vessels on the distal testicular side was adopted as a supplement to dissociate the vasal vessels to be preserved. This improvement ensures the blood supply to the vas deferens that will be used for anastomosis and also provides longer vasal vessels, which reduces the tension of anastomosis. 2) By fixing the vas deferens to be anastomosed and the broken end of the vas deferens, the free vasal vessels get fixed, which resolves the problem of transmission of vas tension to the vasal vessels and reduces the risk of vasal vessel hemorrhage. 3) Dissociation of the vas deferens after opening the tunica vaginalis increases the mobilization of the vas deferens, which also makes the new procedure easier to complete. The evaluation of the outcomes of this new procedure showed that no significant postoperative complications occurred in the patients, and the patency rate was no different from that of the conventional procedure. Therefore, this new, improved procedure can be considered safe, with satisfactory postoperative results.

Introduction

Epididymal obstruction is the most common cause of obstructive azoospermia. Microsurgical vasoepididymostomy (MVE) is the main surgical treatment for epididymal obstruction. Although various MVE techniques^1,2,3,4 have been described previously, a two-needle longitudinal intussusception vasoepididymostomy (LIVE) technique described by Chan et al.^5,6 has been recognized as the gold standard for achieving a superior patency rate⁷. The vasal vessels are typically ....

Protocol

This study was approved by the Ethics Committee of Northwest Women's and Children's Hospital (No. 2021002).

1. Preparations

1. Place the patient supine on the operating table and perform anesthesia as per the anesthetist's recommendations.
2. Insert a 16Fr Foley catheter around the incision site after the field is disinfected and covered with surgical drapes.

2. Modified vessel-sparing LIVE

1. Create a 3 cm vertical incision in the middle of the scrotum and deliver the testis from the incision.
2. Open the tunica vaginalis. Caref....

Results

A total of 51 patients who underwent vasoepididymostomy at our center between February 2018 and November 2020 were retrospectively analyzed. Considering the anastomotic tension, the modified procedure was performed only in patients with obstruction at the corpus or caudal epididymal, and these patients were included in the current study. Semen examination was performed 1.5 months after the surgery, and the patients were followed up for more than 1 year. Relevant data of patients with the results of at least one semen tes.......

Discussion

Vessel-sparing microsurgical vasoepididymostomy might have some clinical significance. Although it is not confirmed that this approach can improve the patency rate, it might better simulate the normal physiological structure and has certain significance for patients who have undergone varicocelectomy. This can be attributed to the fact that preservation of the deferential artery and vas deferens vein have positive effects on the blood supply to the testis after varicocelectomy and the venous return of the testis, respect.......

Materials

Name	Company	Catalog Number	Comments
11-0 microsutures	Ningbo Medical Needle Co.,Ltd	211115	Double-armed microsurgical nylon suture length: 5 cm
15° ophthalmic knife	pearsalls limited	72-1501	open the epididymal tubule
2-0 silk braided non-absorbable suture	Coated	1604-51	Ligation of the vas deferens
24-Gangiocatheter sheath	Melsungen AG	4253523-03	injection
5-0 silk braided non-absorbable suture	Johnson & Johnson	SA82G	Ligation of blood vessels
8-0 microsutures	Johnson & Johnson	W2908	Single-armed microsurgical nylon suture length: 13 cm
Deferens separating forceps	Shanghai Medical Instrument Co., Ltd	JCZ210	Separation of vas deferens
Micro scissors	Shanghai Medical Instrument Co., Ltd	WA1040	Microsurgical operation
Microforceps	Shanghai Medical Instrument Co., Ltd	WA3090	Microsurgical operation
Microneedle holder	Shanghai Medical Instrument Co., Ltd	WA2040	Microsurgical operation
Operating microscope	Leica Microsystems(Sch weiz) AG	M525MS3	Microsurgical operation