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Marc Goldstein - One of the best experts on this subject based on the ideXlab platform.
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Vasovasostomy: kinetics and predictors of patency
Fertility and sterility, 2020Co-Authors: Nicholas J. Farber, Ryan Flannigan, Arnav Srivastava, Hanhan Wang, Marc GoldsteinAbstract:Objective To assess the timing of patency and late failure (secondary azoospermia) after Vasovasostomy (VV) using standardized kinetics definitions. Design Retrospective cohort study. Setting University-affiliated hospital. Patient(s) Patients with obstructive azoospermia. Intervention(s) Vasovasostomy. Main Outcome Measure(s) Univariate and multivariate logistic regression assessed predictors of patency and late failure. Patency was defined as any sperm return to the ejaculate; and >2 million total motile sperm (TMS) in ejaculate. Late failure after VV was defined as azoospermia; or Result(s) 429 men underwent VV, with median follow up of 242 days. Mean time to patency was 3.25 months versus 5.29 months in the “any sperm” versus “>2 million TMS” groups. Finding sperm intraoperatively during VV significantly improved patency rates in multivariable analysis (odds ratio [OR] 4.22). This association was further boosted when sperm was found bilaterally (OR 6.70). Late failure rate (azoospermia) was 10.6% at mean time of 14.1 months and 23% for Conclusion(s) Vasovasostomy remains highly efficacious in treating obstructive azoospermia. Young patients, shorter obstructive intervals, and sperm identified intraoperatively predict improved outcomes. Clinicians can expect VV patency in 3 months and late failure within the first 2 years after surgery. However, patency rates, late failure rates, and kinetics vary by definition.
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The Kinetics of Sperm Return and Late Failure Following Vasovasostomy or Vasoepididymostomy: A Systematic Review
The Journal of urology, 2019Co-Authors: Nicholas J. Farber, Ryan Flannigan, Marc GoldsteinAbstract:Purpose:Vasovasostomy and vasoepididymostomy are technically challenging microsurgical reconstructive procedures necessary for men with obstructive azoospermia at the level of the vas deferens or epididymis. Patency rates following Vasovasostomy or vasoepididymostomy have been widely described in the literature. However, few reports have discussed the timing of sperm return to the ejaculate after reconstruction as well as the proportion of men in whom late failure develops following Vasovasostomy or vasoepididymostomy. Therefore, the objective of this article was to review the rates and predictors associated with late failure and the timing of sperm returning to the ejaculate after Vasovasostomy and vasoepididymostomy.Materials and Methods:A literature search was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines via the PubMed®/MEDLINE® database. We included relevant articles published in English in peer reviewed journals from 1960 to 2017 which rep...
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Outcomes of microsurgical Vasovasostomy for vasectomy reversal: a meta-analysis and systematic review.
Urology, 2015Co-Authors: Lindsey A. Herrel, Marc Goldstein, Michael Goodman, Wayland HsiaoAbstract:Objective To perform a systematic review and meta-analysis of the published literature evaluating Vasovasostomy for vasectomy reversal outcomes. Methods We conducted a review of English language articles describing results of microscopic Vasovasostomy for vasectomy reversal. Two reviewers independently examined the studies for eligibility and evaluated data from each study. Meta-analysis was performed using a random effects model. Results Thirty-one studies with 6633 patients met inclusion criteria. Mean patient age at time of vasectomy reversal was 38.9 years with a mean obstructive interval of 7.2 years. The mean postprocedure patency and pregnancy rates weighted by sample size were 89.4% and 73.0%, respectively. A meta-analysis comparing an obstructive interval (OI) of Conclusion We found no statistically significant difference in Vasovasostomy outcomes when comparing the impact of single vs multilayer anastomoses. Patients with an OI
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Robotic microsurgical Vasovasostomy and vasoepididymostomy in rats.
The international journal of medical robotics + computer assisted surgery : MRCAS, 2005Co-Authors: Jonathan D. Schiff, Marc GoldsteinAbstract:Robotic and robotic assisted procedures are rapidly increasing in popularity amongst practicing surgeons and urologists. Robotic techniques are now commonly used to perform radical prostatectomies for prostate cancer and pyeloplasties for uretero-pelvic junction obstruction. Other robotic procedures include robotic assisted coronary artery bypass and partial nephrectomies. We initially studied the da Vinci surgical robot in order to determine the feasibility of adapting the robot to microsurgical Vasovasostomy and vasoepididymostomy. In this paper, we describe our experience in developing a set of practice exercises using the da Vinci robot to prepare for these microsurgical procedures. We also review the design and results of our studies of robotic microsurgical Vasovasostomy and vasoepididymostomy in rats.Finally, we discuss the potential future roles of robotic microsurgery in urology and surgery.
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Toward a sutureless Vasovasostomy: use of biomaterials and surgical sealants in a rodent Vasovasostomy model.
The Journal of urology, 2004Co-Authors: Jonathan D. Schiff, Marc GoldsteinAbstract:ABSTRACT Purpose: With 500,000 to 800,000 vasectomies performed annually and a reversal rate of 3% to 8% vasectomy reversal has become a commonly performed procedure. Two-layer microsurgical Vasovasostomy remains the gold standard for surgical reconstruction of the vas. However, this procedure is technically demanding and time-consuming. We determined the ability of biomaterials and surgical sealants to decrease the number of sutures used, enhance anastomosis watertightness and decrease operative time. Materials and Methods: Adult male Wistar rats underwent vasectomy 2 weeks prior to Vasovasostomy. Standard 2-layer microsurgical repair was performed in control animals. Experimental groups underwent 3-suture mucosal approximation and then completion of the anastomosis with a biomaterial membrane and/or synthetic sealant. The rats were sacrificed 9 weeks after Vasovasostomy. Anastomotic patency was assessed functionally by the presence of motile sperm in the vas distal to the testes and anastomosis, and mechanically by methylene blue vasogram. The presence and size of sperm granulomas were also recorded. Results: Microsurgical Vasovasostomy required significantly less time when biomaterial (42.7 minutes) or sealant (40 minutes) was used compared to the standard sutured group (102.5 minutes, each p Conclusions: Using a biomaterial wrap during Vasovasostomy resulted in significantly decreased operative time and fewer sperm granulomas than in the control group. Sealants were not effective. Biomaterial wrap may support Vasovasostomy and by decreasing leakage improve the outcome.
Jonathan D. Schiff - One of the best experts on this subject based on the ideXlab platform.
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Robotic microsurgical Vasovasostomy and vasoepididymostomy in rats.
The international journal of medical robotics + computer assisted surgery : MRCAS, 2005Co-Authors: Jonathan D. Schiff, Marc GoldsteinAbstract:Robotic and robotic assisted procedures are rapidly increasing in popularity amongst practicing surgeons and urologists. Robotic techniques are now commonly used to perform radical prostatectomies for prostate cancer and pyeloplasties for uretero-pelvic junction obstruction. Other robotic procedures include robotic assisted coronary artery bypass and partial nephrectomies. We initially studied the da Vinci surgical robot in order to determine the feasibility of adapting the robot to microsurgical Vasovasostomy and vasoepididymostomy. In this paper, we describe our experience in developing a set of practice exercises using the da Vinci robot to prepare for these microsurgical procedures. We also review the design and results of our studies of robotic microsurgical Vasovasostomy and vasoepididymostomy in rats.Finally, we discuss the potential future roles of robotic microsurgery in urology and surgery.
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Toward a sutureless Vasovasostomy: use of biomaterials and surgical sealants in a rodent Vasovasostomy model.
The Journal of urology, 2004Co-Authors: Jonathan D. Schiff, Marc GoldsteinAbstract:ABSTRACT Purpose: With 500,000 to 800,000 vasectomies performed annually and a reversal rate of 3% to 8% vasectomy reversal has become a commonly performed procedure. Two-layer microsurgical Vasovasostomy remains the gold standard for surgical reconstruction of the vas. However, this procedure is technically demanding and time-consuming. We determined the ability of biomaterials and surgical sealants to decrease the number of sutures used, enhance anastomosis watertightness and decrease operative time. Materials and Methods: Adult male Wistar rats underwent vasectomy 2 weeks prior to Vasovasostomy. Standard 2-layer microsurgical repair was performed in control animals. Experimental groups underwent 3-suture mucosal approximation and then completion of the anastomosis with a biomaterial membrane and/or synthetic sealant. The rats were sacrificed 9 weeks after Vasovasostomy. Anastomotic patency was assessed functionally by the presence of motile sperm in the vas distal to the testes and anastomosis, and mechanically by methylene blue vasogram. The presence and size of sperm granulomas were also recorded. Results: Microsurgical Vasovasostomy required significantly less time when biomaterial (42.7 minutes) or sealant (40 minutes) was used compared to the standard sutured group (102.5 minutes, each p Conclusions: Using a biomaterial wrap during Vasovasostomy resulted in significantly decreased operative time and fewer sperm granulomas than in the control group. Sealants were not effective. Biomaterial wrap may support Vasovasostomy and by decreasing leakage improve the outcome.
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Robotic microsurgical Vasovasostomy and vasoepididymostomy: a prospective randomized study in a rat model.
The Journal of urology, 2004Co-Authors: Jonathan D. Schiff, Marc GoldsteinAbstract:ABSTRACTPurpose: Microsurgical Vasovasostomy and vasoepididymostomy remain technically challenging procedures. Refinements in technique have continually improved patency and pregnancy rates for the 2 procedures in experienced hands. Advances in surgical robotics produced the Da Vinci robot (Intuitive Surgical, Inc., Sunnyvale, California) with motion reduction and no tremor, features that may improve outcomes in microsurgery. We report a randomized prospective study of vasoepididymostomy and Vasovasostomy using the Da Vinci robot in rats.Materials and Methods: A total of 24 adult male Wistar rats underwent vasectomy through a midline abdominal incision. Two weeks later the animals were randomized to microsurgical multilayer Vasovasostomy, longitudinal vasoepididymostomy or robotic Vasovasostomy and vasoepididymostomy groups. Outcomes measured included surgical time, complications, patency and sperm granuloma formation at 9 weeks.Results: Animals were sacrificed 9 weeks after microsurgery. There were no si...
Larry I. Lipshultz - One of the best experts on this subject based on the ideXlab platform.
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Vasovasostomy: a step-by-step surgical technique video.
Fertility and sterility, 2013Co-Authors: Tariq S. Hakky, Robert M. Coward, Ryan P. Smith, Jason R. Kovac, Larry I. LipshultzAbstract:Objective To demonstrate a step-by-step microsurgical approach to the two-layered Vasovasostomy technique of an experienced urologic microsurgeon. Design Video presentation. Setting Baylor College of Medicine. Patient(s) This surgical technique video demonstrates a Vasovasostomy of a patient undergoing vasectomy reversal. Intervention(s) Vasovasostomy. Main Outcome Measure(s) Intraoperative technique with commentary highlighting tips for a successful anastomosis. Result(s) Microsurgical Vasovasostomy by a fellowship-trained urologic microsurgeon yields superior results than macrosurgical approaches, particularly when epididymovasostomy is indicated. Patency for our Vasovasostomy technique approaches 100%. The popularity of Vasovasostomy in recent years can be attributed to improvements in operative technique, instrumentation, optics, and most importantly, patency rate. Conclusion(s) This video is the first published video demonstrating a step-by-step technique for two-layered microsurgical Vasovasostomy, as a method of training.
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results of laser tissue soldering in Vasovasostomy and epididymovasostomy experience in the rat animal model
The Journal of Urology, 1997Co-Authors: Eric K Seaman, Edward D. Kim, Andrew J Kirsch, Yu Chuan Pan, Steve Lewitton, Larry I. LipshultzAbstract:AbstractThe use of microsurgical techniques (Vasovasostomy and epididymovasostomy) for vasectomy reversal has now enabled surgeons to perform both procedures with certainly acceptable success rates. However, these operations are technically demanding and require special training in microsurgery.Purpose: A new method of performing these procedures using laser tissue soldering is described and results are evaluated. Laser tissue soldering is different from laser welding in that it involves the laser activation of a protein solder with a dye specific for the specific wavelength of laser light; therefore, surrounding tissue is not affected by the laser.Materials and Methods: Ten rats underwent bilateral Vasovasostomy and eleven underwent bilateral epididymovasostomy. In each rat, a sutured anastomosis was performed on one side while laser tissue soldering was performed on the other. Animals were sacrificed after one month and anastomoses were evaluated for patency and presence of sperm granulomas. Histologic ...
Wayne J G Hellstrom - One of the best experts on this subject based on the ideXlab platform.
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intracorporeal robot assisted microsurgical Vasovasostomy for the treatment of bilateral vasal obstruction occurring following bilateral inguinal hernia repairs with mesh placement
The Journal of Urology, 2014Co-Authors: Landon Trost, Sijo J. Parekattil, Julie Wang, Wayne J G HellstromAbstract:Purpose: Various surgical approaches have been described to manage iatrogenic inguinal vasal obstruction, including open microscopic, laparoscopic and robot-assisted techniques. The open and laparoscopic approaches are often limited in cases of extensive inguinal obstruction or inadequate intra-abdominal vasal length. The robotic approach offers novel opportunities to the operating surgeon, including performing microsurgical anastomoses in traditionally challenging locations. To our knowledge we describe the first intracorporeal robot-assisted, microsurgical Vasovasostomy for iatrogenic vasal obstruction not amenable to standard microscopic repair.Materials and Methods: Bilateral intracorporeal robot-assisted microsurgical Vasovasostomy was performed. The proximal vasa were transected and obstruction of the distal segments was confirmed. After docking the robot the intracorporeal regions of the vasa were transected at the internal ring. The proximal vasal segments were passed intracorporeally and approxim...
Sijo J. Parekattil - One of the best experts on this subject based on the ideXlab platform.
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intracorporeal robot assisted microsurgical Vasovasostomy for the treatment of bilateral vasal obstruction occurring following bilateral inguinal hernia repairs with mesh placement
The Journal of Urology, 2014Co-Authors: Landon Trost, Sijo J. Parekattil, Julie Wang, Wayne J G HellstromAbstract:Purpose: Various surgical approaches have been described to manage iatrogenic inguinal vasal obstruction, including open microscopic, laparoscopic and robot-assisted techniques. The open and laparoscopic approaches are often limited in cases of extensive inguinal obstruction or inadequate intra-abdominal vasal length. The robotic approach offers novel opportunities to the operating surgeon, including performing microsurgical anastomoses in traditionally challenging locations. To our knowledge we describe the first intracorporeal robot-assisted, microsurgical Vasovasostomy for iatrogenic vasal obstruction not amenable to standard microscopic repair.Materials and Methods: Bilateral intracorporeal robot-assisted microsurgical Vasovasostomy was performed. The proximal vasa were transected and obstruction of the distal segments was confirmed. After docking the robot the intracorporeal regions of the vasa were transected at the internal ring. The proximal vasal segments were passed intracorporeally and approxim...
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Video technique for human robot-assisted microsurgical Vasovasostomy.
Journal of endourology, 2010Co-Authors: Sijo J. Parekattil, Hany Atalah, Marc S. CohenAbstract:Abstract Previous studies have shown that robot-assisted microsurgical Vasovasostomy (RAVV) has technical advantages over pure microscopic Vasovasostomy (MVV) in animal and human models. This study presents a video technique and initial results for RAVV in 20 human cases compared with 7 MVV cases by a single fellowship-trained microsurgeon from July 2007 to June 2009. A three-layer 10-0 and 9-0 suture anastomosis was performed with up to 22 months follow-up (mean 3 months). Mean operative duration for the RAVV cases was 109 and 128 minutes for MVV (p = 0.09). At 2 months postoperatively, all patients were patent. Mean sperm count was 54 million in RAVV and 11 million in MVV (p = 0.04). The use of robotic assistance in microsurgical Vasovasostomy may have potential benefit over MVV in decreasing operative duration and significantly improving early semen analysis measures. Further evaluation and longer follow-up is needed to assess its clinical potential.