A novel experience of deferential vessel-sparing microsurgical vasoepididymostomy

Abstract

Microsurgical longitudinal intussusception vasoepididymostomy (LIVE) has been widely used to treat epididymal obstructive azoospermia since 2004. Although the deferential vasculature plays an important role in supplying blood to the testis and epididymis, little attention has been paid to the potential benefits of sparing the deferential vessels during the anastomosis in LIVE. This study aimed to evaluate the efficacy and safety of deferential vessel-sparing LIVE in humans. From December 2013 to December 2015, 69 azoospermic men with epididymal obstruction due to a genital infection, trauma, or idiopathic factors underwent deferential vessel-sparing LIVE in the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. The outcomes of these patients were analyzed retrospectively. The mean age was 31.1 years for men and 28.3 years for their partners. Fifty-nine (85.5%, 59/69) men were followed up after surgery for approximately 16 months. Patency was noted and confirmed by semen analysis (>10 000 sperm/ml) in 83.1% (49/59) of men. The natural pregnancy rate was 40.7% (24/59) by the end of the study, with 87.5% (21/24) of these natural pregnancies achieved within 12 months after surgery. No severe adverse events or complications were observed. In this study, we present a novel technique for sparing the deferential vessels during LIVE. The preliminary outcomes show this technique to be safe with favorable patency and pregnancy rates.

Vasal vessel‐sparing microsurgical single‐armed vasoepididymostomy to epididymal obstructive azoospermia: A retrospective control study

“…After the operation, the patient achieved patency without testicular atrophy, and his wife had a natural pregnancy. Furthermore, Lyu et al (2018) (24/39) and natural pregnancy rate of 35.9% (14/39) for those undergoing non-deferential vessel-sparing LIVE in their previous study (Zhao et al, 2015). Therefore, the preservation of the vas deferens vasculature may have a positive effect on the recovery and the prognosis of EOA.…”

“…Usually, one small vertical branch of the vasal artery supplying the vas deferens were bluntly separated and cauterised by bipolar microsurgical cautery, so we could protect the blood supply of the vas end and achieve a tension-free anastomosis. Doppler ultrasound probe could be used to identify the vasal artery if necessary, to avoid damage to the vas deferens arteries (Lyu et al, 2018;, however, I hardly used it. After the isolating is complete, we transected the vas deferens, and then selected a suitable anastomosis site on the epididymis.…”

“…Theoretically, if the vas deferens vasculature is preserved during VE, blood supply and venous return would be minimally affected, normal physiological structure could be simulated. Zhang et al first introduced the deferential vessel-sparing LIVE (Zhang et al, 2016a), and Lyu et al (2018)reported that it is safe and effective and has favourable patency and pregnancy rates, but without control group. We believed that the preservation of the vas vessel could further improve the prognosis of VE, such as increasing the post-operative patency rate, natural pregnancy rate and reducing surgical complications.…”

A modified single-armed microsurgical vasoepididymostomy for epididymal obstructive azoospermia: intraoperative choice and postoperative consideration

“…Also, we had to dilate the vasal lumen sufficiently wide to pass the needle through the lumen with the aid of a microneedle holder to avoid back-walling during the suture placement. Supposedly, these procedures must be completed before the presence of the sperm in the epididymal fluid [ 19 ]. However, if no sperm was detected, the procedure was repeated 2–4 times, which would significantly increase the time required for the surgery and the fatigue of the surgeon.…”