P-750 A systematic review of vasovasostomy (VV) and vasoepididymostomy (VE) techniques for Vasectomy Reversal: How far have we come?

Abstract Study question A systematic review of current literature evaluating different techniques in performing vasovasostomy (VV) and vasoepididymostomy (VE) including robotic-assisted minimally invasive their outcomes Summary answer Macrosurgical, microsurgical robot-assisted have evidence for use vasectomy reversal. The robotic assistance may benefit over standard techniques. What is known already While a common procedure worldwide, six percent these patients request reversal procedure. Reasons this include change mind, new relationship, death child or wanting more children. sperm harvest combined with in-vitro fertilisation (IVF) an alternative, factors timing patency durability need to be considered prior deciding between harvesting IVF. In 1977, were described by Silber Owen, procedures became following this. differing approaches lacking. design, size, duration was performed using databases Medline PubMed performed, comprising studies 1979 July 30 2022. Systematic articles included. Original on robotic- assisted also Exclusion criteria included animal non-English. Level evaluated. Participants/materials, setting, methods From the eligible identified from above criteria, data extracted used vasoepididymostomy. Surgical pregnancy rates postoperative surgical regarding articles. Data original Main results role chance For vasovasostomy, microscopic mini-incision (MVV), mini incision MVV Moon’s clamp, vasovasostomy. Described surgeons as “most technically challenging procedure”, early approach comprised 3-4cm scrotal delivery testis provide adequate exposure entire epididymis vas deferens. When compared prolonged recovery periods, increased pain swelling identified. comprise end-to end, side, three-suture triangulation intussusception (TIVE), two-suture longitudinal (LIVE), deferential vessel-sparing LIVE, vasoepididymostomy, (RAVE). Retrospective reviews 2-layer anastomosis report rate 85%, similar reports single layer repairs. Microsurgical allow accurate apposition narrow lumen ends, allowing unobstructed semen flow low level suggests high rates. Macrosurgical simple, less expensive quicker alternative. Elzanaty et al. found no clear difference terms vasal patency. Both appeared effective when experienced surgeon. Preliminary reduced morbidity accuracy repair. Limitations, reasons caution With each technique, formal clinical guidelines are not forthcoming. Further evaluation longer follow-up required assess usage true cost-benefit ratio. There standardised measurement tool objective outcome measures compare Wider implications findings This provides available Outcome tools presented, highlighting lack definitions failure. enables determine most effective, efficient cost-effective technique practice. Trial registration number ‘Not applicable'