Commentary on “validation of robot-assisted vasectomy reversal”

Trost et al.6 recently performed the first intracorporeal RAVR for the treatment of bilateral vasal obstruction following bilateral inguinal hernia repairs with mesh placement. This case is relatively uncommon, and the procedure was technically challenging, but successful, with delivery of a healthy child. Intracorporeal RAVR has the advantage of bypassing the inguinal segment, which precludes the need for inguinal dissection, eliminates the risk of recurrent hernia, improves tissue quality of the anastomotic segment, and avoids a very large abdominal incision with standard microsurgical and open approaches. The learning curve for robotic-assisted microsurgery remains unknown. To date, there have been no studies directly comparing the learning curves between MVR and RAVR. One study aimed to compare outcomes of vascular anastomosis between fully trained surgeons and midlevel surgical residents. Both groups performed standard microsurgical anastomoses and robotic-assisted microsurgical anastomoses. Both were able to master the robotically assisted procedure equally.7 Similar to the study from Santomauro et al.,5 there was no statistically significant difference in mean console time between fully-trained surgeons and residents for RAVR. As such, one may speculate that RAVR might be mastered without the advanced microsurgical skills required for MVR. Robot-assisted VR is an intriguing area for future research and may become the standard of care for VR. For that to happen, however, large-scale prospective randomized controlled trials are needed to validate its wider adoption.