Microsurgical Vasectomy Reversal
Robert U. Finnerty M.D. FACS
Microsurgical Vasectomy Reversal
Robert U. Finnerty M.D. FACS

About Microsurgery

operating microscope with surgeon

Microsurgery is a subspecialty of surgery involved in reconstruction of small anatomic structures. It was developed initially in the 1960’s to facilitate the repair of tiny blood vessels, using an operating microscope and surgical techniques already in use for ear surgery. It soon found wide application, especially in hand surgery and reconstructive plastic surgery. In the 1970”s, urological surgeons and infertility specialists began to apply microsurgical techniques to the management of sterilization reversal, especially fallopian tube reconstruction in women and vasectomy reversal in men.

Before microsurgery, vasectomy reversal had been attempted for many years, with almost universally poor results. Many variations of non-microsurgical techniques were developed to improve the success rates, including the use of stents and optical magnification with jeweler’s loops. However, very little progress was made until the introduction of true microsurgical technique. Epididymal reconstruction prior to the use of microsurgery always failed, and was rarely if ever attempted. This led to the general presumption that vasectomy could not be reversed with any reliability, and should not even be undertaken after 10 years post vasectomy.

Since the advent of microsurgical techniques, such generalizations are no longer true.

The Operating Microscope

Operating microscope headThe first critical element in microsurgery is the operating microscope. These come in a wide variety of manufacturers and capabilities depending on their specific surgical use. They all share common features, however. There is a heavy movable stand and pedestal for stability, with an attached articulating arm which allows the optical portion to swing over the surgical area. The optical head generally has one or two pairs of binocular eyepieces, and a high intensity light source, allowing the surgeon (and an assistant, if one is needed) to see the operating area in high magnification (generally 15-40x) while having the hands free. The more sophisticated microscopes have foot pedal power control over zoom, focus, light, and position.

Microsurgical Instruments

microsurgical instrumentsSpecialized instruments have been developed to allow surgeons to work under high magnification with exceedingly small sutures. These instruments are machined to exacting tolerances, and must be treated with utmost care. Many microsurgical specialists purchase and maintain their own micro instruments to insure that they remain in perfect condition.

Microsurgical Suture

The sutures (stitches) used in microsurgery are extraordinarily fine. They are made from a monofilament nylon, and cannot be seen by the unaided eye unless they are against a white background. Each suture is manufactured by hand. To get some idea of the size of the structures repaired, take a look at a penny. The “o” in “God” is approximately the diameter of the inner layer of the vas deferens (0.2-0.3 mm); the epididymal tubule is about half this size — and far more delicate. Between 6 and 8 sutures are typically placed around the inner, mucosal layer of the vas, and a second outer layer (for mechanical strength) generally requires 8-12 sutures. Epididymal repair (VE) will use between 2 and 6 sutures on the tubule, depending on size and the specific technique used.


Additional Information About Microsurgery

A little over 5 years ago, my husband and I flew from Chicago to your office to have his vasectomy reversed. We both want you to know how grateful we are -- to you, to your staff, and for your expertise. Since the surgery, we have had Michael (almost 4!) and Mary Jo (10 months) ... We feel it is important for you to know what a difference you made in our lives, and what an awesome grace it was to have you as our surgeon. Words cannot convey how much we appreciate what you have made possible for us -- we will be eternally grateful!
C. & K.P., Chicago
Thank you for helping our dreams come true.
J.W., Atlanta
The reversal surgery was a great success! We are sorry we didn''t contact you sooner. Thank you again for your willingness to provide such a special service for families.
M.F., California
A child is God''s most precious gift. We joyfully announce the birth of our son.
J.C., Idaho
My husband had his vasectomy nearly 13 years before the reversal, which resulted in the birth of our daughter.
R.B., California
My husband had a vasectomy reversal four and one-half years ago performed by Dr. Finnerty. Three and one half years after, we were able to conceive a child. Our daughter is such a constant joy in our lives.
C.J., California
We wanted to share our delightful news with you. We were blessed with a beautiful baby daughter in October.
D.W, Oregon
Our child is a true gift from God. God bless you for turning my vasectomy around after 30 years with so much care and love. We will always love you.
J.C., Tennessee
We have been so excited about our new son and he has been such a joyous addition to our family ... Thank you so much for your devotion and belief in vasectomy reversal, we have been so blessed by our little guy. Of course, he can never take the place of our daughter who died, but he sure brings new joy to us ... Again, thank you for all you did! We have been so blessed....
M.M., Camas, WA
Our family now has 7 blessings, 3 of which you had a very special part in. Thank you!
G.S., Alaska
We were very excited to learn just before Christmas that the surgery was a success. We saved the news for out kids until Christmas Eve and what a blessing their reaction was, it couldn''t have been a better Christmas present! We do thank you so much for providing your services at realistic fees, we could never have done it had there not been options other than what we found locally.
T.S., California
I am writing to send our heartfelt thanks to you for your expertise. On September 9th, you performed my husband''s procedure. Three weeks later, we conceived our first daughter. She was born exactly 43 weeks post-op. Since then, we have welcomed a son and also another daughter. We''ll always be grateful.
M.H., Vancouver, WA
Thank you again for making possible the blessings God had in store for us in the way of children ...
T.P., Minnesota
Easter blessings to you and your family from us. We are having a special celebration and invite you to join us -- we celebrate the life of our new daughter.
C.K., California
My wife and I would like to give you and your staff a hearty "thank you" for the professionalism and care given us...following my son''s departure to our heavenly Father. Your calming manner and assurance that we had a reasonable chance at reattaching my vas deferens, which might allow us to get pregnant, was at fruition soon after our stay in Tacoma. 14 days following the procedure, my wife ... had become pregnant!. We lost our first son, and Dr. Finnerty, touched by God, enabled us to have another son ...
J.G., Washington
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