Micro-Reversal

Successful Microsurgical Vasectomy Reversal
~ Cutting Edge Technology ~

Today, vasectomy reversal has become a reality due to the development of microsurgical techniques. The operating microscope allows the tiny lumen of the vas deferens to be re-approximated in perfect alignment. Special microsurgical sutures have been developed which are less than 20 microns in diameter (size 10-0 sutures -- a human hair is 2-3 times larger). These sutures are extremely inert, eliminating tissue reaction, which allows complete healing of the vas without any inflammatory response. This microsurgical technique done under high power with an operating microscope is far superior to techniques using the naked eye and optical loupes or laser technology. Loupes are magnifying glasses that can enhance viewing up to 3.5X to 6X power, whereas the operating room microscope can magnify up to 40X. Laser technology still requires microsurgical suturing technique and results are not superior to standard microsurgical methods.

Dr. Gatewood utilizes a Zeiss Operating Microscope which has the capability of enlarging an object 40 times its size. He uses a special Zeiss Microsurgical Chair, one of 2 in the United States, which is ergonomically correct. Dr. Gatewood uses 10-0 nylon microsurgical sutures with a 70 micro needle to perform an inner layer to exactly align the lumen of the vas. He then uses a 9-0 nylon suture to close the outer muscular wall of the vas for a second layer.

Dr. Gatewood and his staff have a very optimistic attitude regarding vasectomy reversals.

He observes the fluid from the testicular end of the vas after the old vasectomy site has been dissected out. If the fluid is clear or opalescent then motile or non-motile sperm are seen under the microscope. Sometimes sperm heads or sperm with broken tails are seen. This is good quality fluid and a reversal is likely to work under these circumstances.

If the fluid is very thick and pasty and there does not seem to be any sperm present, this could indicate epididymal damage caused from back pressure from the vasectomy. The epididymus is a structure along side the testicle which takes sperm that the testicle makes and passes it through a long coiled duct where it joins the vas at the bottom of the testicle. Frequently, a "blow-out" is present in the epididymal duct which obstructs the duct at that point. A regular reversal will not work in that setting. If sufficient length is present from the abdominal or upper end of the vas it is possible to sew the lumen of the vas to the epididymal duct above the "blow-out" where sperm quality is good. This procedure is called a vasoepididymostomy and is done only if a blow-out is found.

The ability to do both a vas reversal and an epididymostomy in the same setting, if it is needed, gives each patient the best opportunity for pregnancy.

Dr. Gatewood also does "re-do's" of previous vasectomy reversals, by other doctors, that have failed.

Post-operative technical success is best measured by the patency rate. The patency rate (the percentage of patients with sperm in the ejaculate) is greater than pregnancy rate. In achieving a pregnancy, multiple factors are involved other than having a patent vas and being able to produce viable sperm. Female fertility factors, for example, become important. For high patency much depends on the surgical technique, the dexterity and experience of the surgeon, and the condition of the vas found at the time of surgery.

Dr. Gatewood updates his results on a quarterly basis. His overall patency rate is 96%. This includes vasectomies as old as 30 years. He also has a 89% patency rate with bilateral vasoepididymostomies. He is especially proud of his results on vasectomies older that 20 years. For more detailed statistical information, please contact our office.

Data indicates that pregnancy is indeed possible even if the vas deferens has been obstructed for a long period of time.