Single Incision Vasectomy Reversal (SIVR)

This video highlights the 'Single Incision Vasectomy Reversal'. An innovative surgical technique developed by Dr. Ethan Grober. The entire vasectomy reversal, on both sides, is completed through a single, mini, midline incision that is less than 1cm. By minimizing the number and size of the incisions, patients recover from surgery faster with significantly less pain - all without compromising the highest-quality surgical outcomes.


SINGLE INCISION VASECTOMY REVERSAL (SIVR)

Ethan Grober MD, MEd, Mary Samplaski MD University of Toronto, Division of Urology, Mount Sinai & Women's College Hospital, Toronto, Ontario

Objective:
To describe the Single Incision Vasectomy Reversal (SIVR). An innovative approach to vasectomy reversal (VR) by which the entire procedure is performed through a single midline mini−incision.

Materials and Methods:
A SIVR was considered in the absence of large vasal gaps, sperm granulomas or limited mobility of the scrotal contents. As in the no−scalpel vasectomy (NSV), the SIVR begins by stabilizing the vas directly under the scrotal skin at the midline raphae.

The NSV ring clamp is used to capture the vas at the vasectomy occlusion site. A single small (<1cm) opening in the skin is created and the vas is delivered through the midline incision.

The mobile and compliant the scrotal skin allows the vas to be delivered through the opening despite the small size of the incision. Once both ends of the vas have been delivered, the anastamosis is completed according to surgeon preference.

The contra−lateral vas is approached via the same incision but through separate opening in the dartos muscle to ensure a tension−free anastamosis. The small opening in the skin closed with a single dissolvable suture.

Results:
Of 104 consecutive vasovasostomy VR, a SIVR was attempted in 22 patients (21%). Mean patient age was 39 years (range: 29−48) with a mean vasal obstructive interval of 5.2 years (range: 3 months−11 years).

Post−operative semen parameters and/or a confirmed pregnancy was available in 10 men. Patency was established in all patients.

Mean sperm concentrations and % motile sperm were 27 million/ml and 56%, respectively. In one patient, a superficial hematoma was identified that resolved with conservative management.

Conclusions:
A SIVR is feasible without compromising patency rates or semen parameters and may translate into less postoperative discomfort and quicker functional recovery.