Narrative review of the history of microsurgery in urological practice

Technological Advancements in Male Infertility Microsurgery

“…Carl Zeiss opened a microscope workshop in Germany in 1848, and Zeiss became the first mass producer of high-quality microscopes in the mid-to-late 1800s. Microscopes were first introduced into the operating room in otolaryngology at the University of Sweden in 1921, where Dr. Carl Olof Nylen modified a dissecting microscope to perform middle ear procedures [ 3 , 4 , 5 , 6 ]. Following this, Dr. Richard Peritt began using an “operating” microscope in ophthalmology in 1946 at Loyola University for cataract surgery [ 3 ].…”

“…Microscopes were first introduced into the operating room in otolaryngology at the University of Sweden in 1921, where Dr. Carl Olof Nylen modified a dissecting microscope to perform middle ear procedures [ 3 , 4 , 5 , 6 ]. Following this, Dr. Richard Peritt began using an “operating” microscope in ophthalmology in 1946 at Loyola University for cataract surgery [ 3 ]. The concept of an operating microscope was introduced into urology in the 1970s, and it was first used to treat vasal epididymal obstruction by Drs.…”

“…Vasal obstruction most commonly occurs secondary to prior vasectomy, a procedure where the vas deferens is intentionally severed as a method of permanent contraception. The process of reconnecting the two cut ends of the vas deferens, or “vasovasostomy (VV)”, is a technically and mentally challenging anastomosis, as the human vasal lumen is approximately 250 um (0.25 mm) in diameter [ 3 ]. Furthermore, if intraoperative testing determines an epididymal obstruction is present, a connection between the vasal lumen and an epididymal tubule, termed “vaso-epididymostomy (VE)”, the most technically challenging microsurgical anastomosis, must be performed.…”

“…In 1999, a triangulation end-to-side intussusception VE was introduced by Dr. Berger, and it was modified by Dr. Chan et al, as a longitudinal two suture VE in 2003 [ 12 , 13 ]. In this procedure, an epididymal tubule was sutured to the cut end of the vas deferens, but anastomosed in such a way as to invaginate the epididymal tubule into the vasal lumen [ 3 , 12 , 14 , 15 ]. These technical advances, including a single-armed longitudinal VE that was developed at Weill Cornell in 2007, have greatly improved patency success rates following VV and VE [ 16 ].…”

“…The concept of an operating microscope was introduced into urology in the 1970s, and it was first used to treat vasal epididymal obstruction by Drs. Owen and Silber [3,7,8]. From here, microsurgery has greatly expanded, and has become the standard in reproductive microsurgeries in urology for many procedures, including vasal reconstruction, varicocele repair, and sperm retrieval.…”