Case report In Vivo Robotassisted Vasovasostomy

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Case report In Vivo Robot-assisted Vasovasostomy
A 34-year old man seeked for refertilisation
A. Mottrie Department of Urology Onze-Lieve-Vrouwz
iekenhuis, Aalst Belgium
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Case report

• A 34-year old man seeked for refertilisation.
• indication for vaso-vasostomy
• Need for microscope for enlargement of operating
  field
• So, why not use of Da Vinci?
• Enlargement of of operating field
• Stable vision 3D
• Microforcepses very stable
• Unprecision of human handling is
• filtered out

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Benefits of da Vinci robot ?
? Better visualisation

• Superior 3 D - Visualisation
• Larger magnification
• (scaling up to 10 times)
• Steadiness of the camera
• (no camera-assistant/ ergonomic)

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Benefits of da Vinci robot ?
? enhanced dexterity and precision

• better eye-hand coordination
• more degrees of freedom
• with endowrist instruments
• no counter-intuitive movements
• tremor elimination (miniaturisation 51)

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Benefits of da Vinci robot ?
? Surgeons comfort

• Enhanced ergonomy

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Vasectomy reversalhistory

• 1919 first vasovasostomy (Quinby)
• 1977 microsurgical anastomosis
• (Owen Silber)
• 2002 robot-assisted microsurgical
• vasovasostomy (Graham)

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Vasectomy reversaltechnique
one layer technique two layer technique
No statistical difference in outcome
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Case report

• A 34-year old man seeked for refertilisation.
• Preparation of the both vasal ends on
• the conventional manner.
• Centering of the 0 robot camera and
• robotic arms (loaded with micro-
• surgical robotic needle holders) over
• the scrotum.
• Performing the vasovasal anastomosis with six
  equally spaced
• single layer full-tickness sutures with a 8-0
  Prolene suture on a 6,5 mm long 3/8 circle
  needle.

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The video
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Results

• No per- or postoperative
• problems encountered.
• Procedure time of 120 min.
• of which 80 min. robotic
• assistance.
• A semen analysis after 3 months showed 120 x 106
  viable spermatozoa /ml which confirms a patent
  anastomosis.

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Conclusion

• This case report shows that robot-assisted
  vasovasostomy is feasible and technically
  possible.
• We believe that robot-assisted vasovasostomy can
  be made with greater ease and precision than
  conventional microscope assisted vasovasostomy
  due to
• better 3-dimensional visualisation
• stable image
• easier instrument manipulation with endowrist
• technique
• finer suturing through motion scaling (best set
• at a ratio of 51)
• elimination of tremor
• more comfort for surgeon