A Modified Vessel-Sparing Microsurgical Vasoepididymostomy

The protocol describes the development of a novel vessel-sparing MVE. The procedure not only ensures the patency rate but also increases the safety of the surgery. This procedure can complete MVE without destroying the normal physiological structure.

It's a safe procedure that may enhance blood supply and venous return to the testes. To begin, make a three centimeter vertical incision in the middle of the scrotum and deliver the testes from the incision. Open the tunica vaginalis.

Carefully dissociate the vas deferens and adjacent vessels. The dissociated length is approximately five centimeters. Create a buttonhole of a diameter of five millimeters at the tunica of cauda epididymis using micro scissors.

Identify a dilated epididymal tubule and carefully dissociate it using micro forceps. Place two needles of double armed 11-0 microsutures longitudinally in the selected epididymal tubule and open the epididymal tubule longitudinally between the two needles using a 15 degree ophthalmic knife. Sample some epididymal fluid flowing from the incision in the tubule with a glass slide.

Gently pull out two needles in the epididymal tubule, separately if sperm are found. Make a puncture in the gap between the vas deferens and adjacent vessels using deferens separating forceps. Completely transect the vas deferens above the deferens separating forceps with a knife and preserve the vasal vessels below the deferens separating forceps.

Cannulate the 24 gauge angiocatheter sheath into the vas deferens lumen on the distal testicular side followed by a bolus injection of diluted methylene blue. Observe the color of the urine. Dissociate the vas deferens on the proximal testicular side using micro scissors to separate it from the vasal vessels.

Then ligate the broken end of the vas deferens and remove the dissociated vas deferens. Carefully separate the vas deferens on the distal testicular side from the vasal vessels using deferens separating forceps combined with micro scissors. Fix the vas deferens to the anastomosis with the tunica vaginalis using 8-0 microsutures at the included angle between the vas deferens and adjacent vessels.

After fixation, ensure that the lumen of the vas deferens reaches the anastomosis site with no significant tension. Fix the muscularis edge of the vas deferens and epididymis tunica using three four interrupted 8-0 microsutures. Pass the four needles of 11-0 micro sutures in the epididymal tubule through four points on the cutting surface of the vas deferens in an inside-out fashion.

Then perform the intussusception of the epididymal tubule into the vas deferens. Suture the muscularis edge of the vas deferens and the epididymal tunica using 10 to 12 interrupted sutures of 8-0 microsutures. Fix the broken end of the vas deferens on the tunica vaginalis using three to four interrupted sutures of 8-0 microsutures.

Ensure that the free vasal vessels are fixed and cannot move. Among the 51 cases, 22 were treated using the new method and spermatozoa were detected in the postoperative semen in 19 cases. The postoperative patency rate was 86.4%Among the 29 cases who underwent the conventional procedure spermatozoa were detected in 25 cases and the postoperative patency rate was 86.2%There was no statistically significant difference in the postoperative patency rate between the two groups and there was no postoperative scrotal hematoma, scrotal pain, or testicular atrophy.

The fixation of vasal vessels is the most important thing when attempting this procedure. Improving the dissociation of the vasal vessels can be attempted and may shorten the operative time. This new procedure not only ensures the patency rate but also increases the safety of the surgery.