We perform only microsurgical vasectomy reversals using a state of the art, high-powered surgical microscope. Only the highest quality microsurgical instruments are used. Microsurgical methods enable the best possible visualization of the vas deferens allowing accurate and precise placement of each suture. Scientific studies show that operating microscopes lead to superior results by comparison with the use of lesser magnification methods such as magnifying glasses. Using a multi-layer technique of extremely fine sutures provides far better results than older less precise techniques and also permits an uneventful recovery. Your entire procedure is performed by Dr Woolcott - there are no registrars, residents, fellows or medical students in training doing any part of your reversal. Each suture is placed precisely by me; therefore assuring you the optimal chance of success
Following consultation and consideration of the benefits, disadvantages, complications and pregnancy rates of vasectomy reversal, we will arrange admission to hospital. You should inform our anaesthetist of any past or present medical problems, medications you are taking and of any allergies. You should not have anything to eat or drink from the evening before your surgery.
Our anaesthetic and surgical nursing staff are highly experienced and together they have been performing reversals for many years. A light general anaesthetic is given and throughout your reversal your heart rate, blood pressure, breathing, and oxygen level are continually monitored to insure your safety.
To perform a vasectomy reversal two incisions of about 2.5cm are made on either side of the scrotum above the testes. These permit access to the scrotal contents including the vas deferens, testes and epididymis.
This involves manually identifying the structures of the scrotum, in particular making note of the vas deferens and the site of the previous vasectomy. The amount of vas deferens which is absent or damaged is assessed along with the available length remaining for re-anastomosis. Occasionally so much vas deferens has been damaged that it is necessary to consider a different surgical technique called microsurgical vaso-epididymostomy. Provided that the anatomy remains acceptable and there is sufficient vas deferens remaining a decision is made to proceed to dissecting the vas deferens for reversal.
Following exploration to assess suitability for reversal (which is almost always possible), the vas deferens is then dissected free of the surrounding tissue. The area of the prior vasectomy usually remains adherent within scar tissue - it is however universally possible to identify normal vas deferens on either side of the vasectomy site. Having freed the vas deferens it is then cut on either side of the vasectomy site so that a normal open tube is available for re-anastomosis of each end.
The cut ends of the vas deferens are brought into close proximity with each other and stabilised in position by a small non-traumatic clip. An operating microscope is then used to magnify the site of the microsurgery approximately 40 times. A series of very fine microscopic sutures (much finer than a human hair) are then placed around the circumference of the lumen of the vas deferens (which is less in diameter of a pin) to bring the ends together and establish patency (microsurgical vaso-vasostomy). Once this has been achieved a second layer of sutures is then added to provide support and stability to the site of the anastomosis. These secondary sutures reduce the risk of movement and therefore excess scarring following the operation. It is always possible to visibly see the ends of the vas deferens come together and be certain at the time of the surgery that the vas deferens is open.
Each patient is different and indeed doctors performing vasectomy do so in a variety of different ways. Because of my extensive microsurgical experience I am able to adapt the multitude of differing surgical challenges presented, so that should it not be possible to re-connect vas deferens to vas deferens to permit the passage of sperm (vaso-vasostomy - as is usually the case) I will immediately connect the epididymus to the vas deferens (vaso-epididymostomy). The sole aim of both microsurgical techniques is to restore fertility. When microsurgical epididymostomy is necessary the vas deferens is attached to the epididymis by a series of circumferential sutures that are even finer than those used for vaso-vasostomy.
Drainage of the surgical site is exceptionally important in minimising the chance of complications and maximising the success rate of vasectomy reversal.
Two small soft drains are placed on either side of the scrotum near the site of the vasectomy reversal. The drains act to prevent an accumulation of fluid and blood near the operation site. The primary benefit is that they minimise the rate of haematoma (a collection of blood). The stated rate of haematoma in the published studies on vasectomy reversal is approximately 5%. Since commencing the use of drains my haematoma rate has been less than 0.5% - a 10 fold reduction in this significant complication. Moreover, an accumulation of tissue can act as a culture medium for infection – drains act to minimise this risk. Finally and most importantly, the avoidance of tension on the site of the vasectomy reversal maximises normal healing and hence gives you the highest chance of successfully restoring fertility.
Once the microsurgery is finished the scrotum is closed in two layers: the first an inner continuous suture to bring the tissues together, and then the skin edges are brought together and closed by a very fine subcutaneous stitch.
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