Robotics and Fertility
Click Here to View a Vasectomy Reversal Video Using Robotic TechnologyInitial Evaluation of Robotic Technology for Microsurgical Vasovasostomy
Wayne Kuang, Paul R. Shin, Surena Matin and Anthony J. Thomas Jr.
Purpose: Conventional microscope-assisted vasovasostomy (MAVV) is a technically difficult procedure that is most successful in the hands of well-trained microsurgeons. Robotics may help surgeons overcome the microsurgical challenges of tremor, limited dexterity, miniaturized instrumentation and the use of fine suture. This initial experience determines the feasibility of a robotic-assisted vasovasostomy (RAVV) and compares performance measures with those of conventional MAVV.
Materials and Methods: One surgeon performed 10 vasovasostomies with a modified 1-layer technique and 9-0 suture on fresh human vas specimens—5 RAVV using the da Vinci robot and 5 MAVV using standard microsurgical instrumentation. Prespecified performance measures and adverse haptic events (broken sutures, bent needles or loose stitches) were recorded. Patency was evaluated by instilling saline through the anastomoses.
Results: The mean operating time and the number of adverse haptic events were higher for the RAVV than for the MAVV (84 vs. 38 minutes [P=0.01]; 2.4 vs. 0.0 events [P=0.03]). The number of needle passes required for the six full-thickness stitches was similar in both groups (16.8 vs. 15.2 passes [P=0.55]). Although no tremor occurred during the RAVV, minimal to moderate amounts occurred during MAVV. Minimal fatigue was noted for both groups. Patency was confirmed in all 10 operations.
Conclusions: The use of RAVV in this human ex vivo vas model was feasible. While the RAVV took longer to perform and was associated with adverse haptic events, the elimination of tremor and the comparable patency rates suggest that it may be a viable surgical alternative for microsurgical vasovasostomy.
Robotic-Assisted Vasovasostomy: A Two-Layer Technique in an Animal Model
Wayne Kuang, Paul R. Shin, Mehmet Oder and Anthony J. Thomas Jr.
Objective: Microscope-assisted vasovasostomy (MAVV) is a technically challenging procedure. Robotics may be a surgical adjunct that helps overcome microsurgical challenges that include fine suture, delicate instruments and tremor. A recent survey revealed that most urologists use a multi-layered technique for vasovasostomies (Crain DS, Roberts JL and Amling CL: Practice patterns in vasectomy reversal surgery: Results of a questionnaire study among practicing urologists. J Urol. 171: 311-5, 2004). This study assesses the feasibility of a multi-layered robotic-assisted vasovasostomy (RAVV) in a rabbit model.
Methods: A surgeon performed 8 vasovasostomies with 10-zero suture and a two-layer technique using an in vivo rabbit model—4 MAVV using conventional microsurgical instrumentation and 4 RAVV using the da Vinci robot. Performance measures and adverse haptic events were recorded. Patency was evaluated by passing a 2-0 prolene suture through the anastomoses.
Results: The mean operating time for the total procedure and for the mucosal layer only was higher for the RAVV than for the MAVV (75 vs. 42 minutes [P=0.03]; 38 vs. 23 minutes [P=0.03]). The needle passes required for the mucosal layer and the number of mucosal and muscularis sutures were similar in both groups (9.5 vs. 8.8 passes [P=0.34], 4 vs. 4 [P>0.99]; 7 vs. 6.3 [P=0.2]). Unlike the MAVV, no tremor was appreciated during the RAVV. No adverse haptic events were observed in either group. All anastomoses were patent, and all rabbits were free of any crush injury.
Conclusions: A multi-layered RAVV can be performed in an in vivo rabbit model. While it is associated with increased operative times, the absence of adverse haptic events and comparable patency rates continue to suggest a role for robotics in microsurgery.