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To investigate which surgical technique, macroscopic, microscopic or robot-assisted microscopic, shows highest postoperative patency- and pregnancy rates for vasectomy reversal (VR) by vasovasostomy (VV). This study is an updated version of the systematic review and meta-analysis entitled: “Outcomes of Macrosurgical Versus Microsurgical Vasovasostomy in Vasectomized Men: a Systematic Review and Meta-analysis” published in 2021. We performed a systematic review of the English-, Dutch-, and German-language literature that described postoperative outcomes of macroscopic, microscopic, or robot-assisted microscopic VV for VR. PubMed National Library of Medicine/MEDLINE, Embase, CENTRAL, The Cochrane Library, Web of Science and Scopus were searched from inception to June 2021. Two reviewers independently examined the studies and associated data for eligibility. Primary outcomes were postoperative patency and pregnancy rates. Data on interval to reversal (≤ 7 years and > 7 years) and postoperative complications were also extracted. Forty-nine studies met the inclusion criteria. We identified 46 retrospective studies and three randomized controlled trials (RCT). A total of 10,088 procedures were included. 6822 patients remained after loss to follow-up. The mean age at reversal of vasectomy was 38.0 years, and the mean interval to reversal was 6.5 years. The pooled mean postoperative patency rate was slightly higher after robot-assisted microsurgical VV (92.7%), compared to macrosurgical (81.9%) and pure microsurgical (90.1%) VV. Postoperative pregnancy rates were 42.7%, 69.7%, and 33.3% after macroscopic, pure microscopic and robot-assisted microscopic VV, respectively. Our results showed that microsurgical and robot-assisted microsurgical VV are associated with higher postoperative patency rates compared to the macrosurgical technique. VV with microsurgical assistance showed the highest post-operative pregnancy rates. However, more research is needed due to lack of RCTs and data on robot-assisted microsurgical VV.

In order to restore fertility by vasectomy reversal, vasovasostomy (VV) is one of the most chosen options. During this procedure, the vas deferens is anastomosed either by a macro- or microscopical technique. Up to date, it is unknown which of these techniques shows best overall post-procedure patency and pregnancy rates. The purpose of this systematic review and meta-analysis is to reach a consensus on which technique is best for vasovasostomy and thereby better counsel patients and practitioners. A systematic review and meta-analysis on macroscopic and microscopic VV for vasectomy reversal was performed. PubMed, The Cochrane Library, Embase, and Web of Science were systematically searched from inception until 2019. Studies and associated data were evaluated by two reviewers. Primary, data on post-operative patency and pregnancy rates, interval to reversal, and post-operative complications were extracted. Proportions (95% CI) and heterogeneity scores (I2) were calculated, using a random effects model. A total of 8305 patients were included by 25 studies. Descriptive analysis showed higher post-operative patency (80.5% vs 91.4%) and pregnancy rates (47.7% vs 73.3%) after microscopic vasovasostomy. Meta-analysis produced post-operative patency proportions of 0.80 (95% CI, 0.76–0.84) and 0.88 (95% CI, 0.83–0.92) after macro- and microscopic VV respectively. Proportions of post-operative pregnancy were 0.43 (95% CI, 0.35–0.50) after macroscopic VV and 0.47 (95% CI, 0.31–0.62) after microsurgical VV. Microscopic VV is associated with higher post-operative patency and pregnancy rates compared to macroscopic vasovasostomy. However, further research is needed because of shortage in high methodological quality and variety.

Background During laparoscopic surgery, CO2 insufflation gas could leak from the intra-abdominal cavity into the operating theater. Medical staff could therefore be exposed to hazardous substances present in leaked gas. Although previous studies have shown that leakage through trocars is a contributing factor, trocar performance over longer periods remains unclear. This study investigates the influence of prolonged instrument manipulation on gas leakage through trocars. Methods Twenty-five trocars with diameters ranging from 10 to 15 mm were included in the study. An experimental model was developed to facilitate instrument manipulation in a trocar under loading. The trocar was mounted to a custom airtight container insufflated with CO2 to a pressure of 15 mmHg, similar to clinical practice. A linear stage was used for prolonged instrument manipulation. At the same time, a fixed load was applied radially to the trocar cannula to mimic the reaction force of the abdominal wall. Gas leakage was measured before, after, and during instrument manipulation. Results After instrument manipulation, leakage rates per trocar varied between 0.0 and 5.58 L/min. No large differences were found between leakage rates before and after prolonged manipulation in static and dynamic measurements. However, the prolonged instrument manipulation did cause visible damage to two trocars and revealed unintended leakage pathways in others that can be related to production flaws. Conclusion Prolonged instrument manipulation did not increase gas leakage rates through trocars, despite damage to some individual trocars. Nevertheless, gas leakage through trocars occurs and is caused by different trocar-specific mechanisms and design issues.

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