Mar 16, 1998
A new technique for vasectomy reversal increases the chances for fertility for men who undergo the procedure.
Developed by Dr. Marc Goldstein, Professor of Urology and Director of Male Reproductive Medicine and Microsurgery at The New York Hospital-Cornell Medical Center, the Microdot technique facilitates more accurate placement of sutures, which, in turn, helps to secure a "leak proof" reconnection of the vas deferens, the sperm conducting tube with an internal diameter of only 1/100 of an inch.
"We make believe that each end of the cut vas deferens is a clockface, and using an operating microscope that magnifies this tiny duct 30 times and a microscopic marking pen, we place 'dots' at 12, 3, 6 and 9 o'clock positions, and an additional four dots in between them," said Dr. Goldstein. "We then reattach the vas deferens by lining up the dots with eight sutures for each layer—inner, middle and outer."
During a vasectomy, the vas deferens, the tube-like structure through which sperm is transported to the penis, is cut bilaterally to create an obstruction. Over time, the testicular side of the vas deferens increases in diameter due to the build up of pressure caused by the storage of sperm, while the abdominal side—only three times the diameter of a human hair—remains unchanged.
"The challenge faced by microsurgeons for a vasectomy reversal is to reattach the two widely discrepant sides of the vas deferens without gaps in order to prevent leakage of sperm and, ultimately, increase chances of fertility," said Dr. Goldstein.
"The Microdot technique facilitates this process. As a result, the overall success rate for return of sperm to the semen after vasectomy reversal has increased from 85 percent (in my first 600 reversals ) to 99.5 percent (in my last 200 reversals) employing the Microdot," he added.
After 17 months of follow-up, 54 percent of the first 100 men have already achieved pregnancies with their female partners. Excluding couples with associated female factor infertility, a 64 percent pregnancy rate was achieved. These results were published in the January issue of The Journal of Urology.