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.

  • Jason Kovac

    It would be interesting to chart the results from this single surgeon study to look and see if there was a learning curve in using this new instrument. Did success rates decrease following the initial introduction of this new technique and then subsequently improve with time?

  • Similar to Dr Ko’s comment, it will be interesting to see if statistical significant improvement (~3%) translate to clinical significance in real world practice. Without meaningful clinical outcome, it will be hard to change practice of 95% patency rate.

  • Technical modifications in tried and true procedures are hard to come by. This article from Kim, Burrows, and Marks highlights a simple modification in vasal cutting by using a 15 degree angled cut vs. the traditional 0 degree cut to transect the vas deferens. By doing so, the surface area for anastomosis increases by about 3.5%. The patency rates also reportedly increase by 3.8% from 95.7% to 99.5% (p = 0.0127). Although the follow up for the angled cut group is only 90 days, it does demonstrate a statistically significant improvement over the straight cut group. Only time will tell if the improvement in patency rates will hold true at 3 months, 6 months, 1 year, and beyond. However, anyone looking to improve their patency rates should consider using this technique to transect the vas deferens.

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