Angled vas cutter for vasovasostomy Technique and results

Capsule:
The angled vas cutting forceps represents a modification of the straight cut technique and has the potential advantage of an increase in vasal surface area for reanastomosis and possible improvement of patency rates.

Authors:
Lindsey E. Crosnoe, B.S., Edward Kim, M.D., Amy R. Perkins, M.S., Matthew B. Marks, B.S., Peter J. Burrows, M.D., Sheldon Marks, M.D.

Volume 101, Issue 3, Pages 636-639.e2, March 2014

Abstract:

Objective:
To describe the technique and results of bilateral vasovasostomy using a 3-mm vas cutting forceps angled at 15° (catalog no. NHF-3.15; ASSI) for vasal transection.

Design:
Retrospective chart review. Institutional review board approval was granted by Western Institutional Review Board.

Setting:
Single vasectomy reversal center.

Patient(s):
Men who underwent a bilateral vasovasostomy at a single institution by a single surgeon between 2001 and 2012 and had a minimum of one semen analysis postoperatively or a reported natural conception.

Intervention(s)
Before September 14, 2010, a straight-edge vas cutter was used on all vasovasostomy connections; 375 men received a bilateral vasovasostomy and met follow-up criteria. Beginning on September 14, 2010, an angled cutter was used on all vasovasostomy patients, with 194 men meeting the exclusion criteria.

Main Outcome Measure(s):
A minimum of 1 × 106 sperm reported on a postoperative semen analysis, or a reported natural conception was used to establish patency.

Result(s):
The overall vasovasostomy patency rate using the angled vas cutter was 99.5% and was 95.7% using the straight vas cutter.

Conclusion(s):
The development of an angled vas cutter provides an increased surface area for vasal wound healing to allow for larger tissue diameter for better healing, resulting in high patency rates after vasovasostomy.

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