A look at how vasectomy reversals are performed

As with most surgical procedures, the steps a medical team takes to perform a vasectomy reversal are methodical. There are some differences in technique, specifically with two clearly different types of repair and multiple additional variations, but for the most part the reversal is performed for the same end result: to restore fertility to men.

The first step once a procedure is underway is to perform anesthesia, and there are several methods depending on the patient. These techniques include: full anesthesia, generally through a breathing tube; moderate through IV; light through oral medicines; or local numbing alone. Sometimes, these are also combined depending on what the patient requests.

From this point, a scrotal incision is made that’s about 1-1.5 inches in length. The prior site of vasectomy is dissected free, and the vas deferens is cut on the testicular side of that previous surgery.
This is where the potential switch in repairs may take place, after fluid is sampled from the cut end. If sperm are present, then a simple repair (or vasovasostomy) can be performed; if not, then the patient receives a complex repair (epididymovasostomy).

In our experience, 30% of men will require a complex repair on one or both sides. Since this information is not known before surgery, it is important that the surgeon who performs the reversal is able to perform complex repairs when needed.
The next step for either case is to make an opening of the vasal side that is closer to the abdomen, so fluid can be passed through this region and to assure that the tube is fully open. This is where the microsurgery begins.

For simple repairs, two layers of small sutures connect the two vas deferens back together with an operating microscope. Typically, 5-6 sutures are placed in the inner lining, while another 6-8 sutures are placed in the outer lining, although the exact number will vary depending on several factors. Prior to or following the micro-anastomosis, additional sutures are then placed to provide additional vasal support (ReVas technique). The vas is then placed back into the scrotum.

For complex repairs, the testicle is delivered through the skin wound, and the epididymis is examined. Once the correct connection area is identified, the vas deferens is brought to that area and secured to the testicle and epididymis. Fine sutures are then used to secure the vas deferens in two layers: four for the inner layer, six to eight for the outer layer. Additional sutures are used to provide strength before the testicle is returned into the scrotum.

Once the connections are completed, the wound is closed in two layers and a sterile bandage is applied. After recovery, testing takes place to then determine the success of the reversal. To find out more about all of our fertility services, go to the Vasectomy Reversal section of our website.

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