Vasectomy reversal (vaso-vasostomy) is a surgical procedure that typically takes between 2-3 hours to perform, depending on the complexity of the specific case. Dr. Green describes it as sewing together two pieces of spaghetti with a tunnel in the middle. A small incision is made in each side of the upper scrotum. After the vas deferens is located, the vasectomy site is identified. Scar tissue is removed and the vas is divided above and below the vasectomy site. The abdominal side of the vas is examined to verify patency, and the testicular side of the vas is inspected for the presence of fluid. If there are sperm present, or if there is freely flowing fluid, the ends of the vas are reconnected.
The key to the success of vasectomy reversal is the skill of the surgeon, optimal magnification, and the use of microscopic sutures. Dr. Green performs the reconnection of the vas with an inner layer of 10-0 Nylon suture and an outer layer of 9-0 Nylon suture, with further buttressing sutures utilized as needed. All sutures are thrown and tied under the operating microscope.
Vaso-epididymostomy (V-E) is indicated if there is no fluid expressed from the vas, or if there is thick and pasty fluid. This can be a sign of epididymal obstruction or possibly a blow out of the epididymis. This is not a common finding if the vasectomy was performed less than 10 years prior to reversal. The epididymal tubules are where the sperm mature before moving into the vas deferens. As such, the connection to the vas at the time of vaso-epididymostomy is performed at the most distal part of the epididymis possible. Dr. Green will perform the V-E procedure if needed at no extra charge at the time of surgery.