Mini-incision microsurgical vasectomy reversal using no-scalpel vasectomy principles and instruments.

OBJECTIVES: Men who have undergone a vasectomy have 2 options available to allow them to have biologically related children: vasectomy reversal or sperm retrieval with in vitro fertilization. Of the men who have undergone vasectomy, 2%-11% eventually undergo reversal. The high cost and reproductive risks associated with in vitro fertilization weigh against sperm retrieval with in vitro fertilization, and the surgical risks and postoperative recovery (eg, time off from work, postoperative pain) are important factors that couples consider before choosing vasectomy reversal. To reduce the morbidity of a vasectomy reversal, we have developed techniques to perform a microsurgical vasectomy reversal through a mini-incision in the scrotum.

METHODS: The vas deferens is grasped through the skin with the no-scalpel vasectomy ring forceps, a 1-cm incision is made through the skin and dartos directly on top of the elevated vas deferens, and the latter is delivered into the surgical field. The other side of the vas is delivered through the same incision in a similar fashion, and the anastomosis is performed with the usual technique.

RESULTS: Application of the no-scalpel vasectomy principals and instruments have allowed us to minimize the scrotal incision (generally to </=1 cm after closure) without compromising the quality of reversal or the operative time.

CONCLUSIONS: Although the no-scalpel vasectomy technique has been proved to reduce morbidity compared with "standard" vasectomy, whether the use of the no-scalpel principles and instruments in a vasectomy reversal translates into a decrease in surgical morbidity is unknown.