Microsurgical Vasectomy Reversals

K.E., Alaska

admin — Thu, 28 Feb 2008 05:44:20 +0000

My husband had his reversal done on June 2007, and I’m happy to announce we are due on June 2008 with a big baby boy!!! We were so shocked that it all happened so fast, but we are very happy. You and your staff made it a wonderful experience from my 1st phone call to Shelby. Everyone was so polite and kind… It is amazing that my husband had his vasectomy for 8 1/2 years and it only took 2 1/2 months to get pregnant. Even my OB-GYN was shocked that that I got pregnant so fast. He said you must really know your stuff.

Once again, thank you so much, you helped complete our family!!

Does an epididymal repair always have to be done in the upper part of the epididymis?

admin — Fri, 30 Nov 2007 04:00:39 +0000

The location of an epididymal repair (distal, mid or proximal) is determined by specific findings at surgery. The standard approach Dr. Finnerty has used in the past has been to leave as much epididymis as possible, to maximize both storage capacity and length for sperm maturation. But his experience has been that this often leads to technical success with poor sperm motility. The reason for this is twofold:

1) The presence of non-motile or degenerating sperm in the mid or distal epididymal fluid does not prove that you are above the obstruction. When fluid is sampled from a point higher in the epididymis, the transition is often striking — you go from no active sperm to 70% active sperm or greater. There is usually a visual transition zone above which this change is seen.

2) In the normal, unobstructed epididymis, motility/fertility is not seen until you get more distally (lower) in the epididymis. In the obstructed epididymis, however, motility is seen much more proximally (higher), suggesting that a change in the physiology of the epididymis occurs after vasectomy. This is why aspiration in the proximal epididymis produces better quality sperm for IVF.

There is a trade-off to doing a VE more proximally: less sperm storage capacity. But the advantage is that by going high enough to find motile sperm when possible (not always there, unfortunately), postoperative sperm counts show substantially better motility. This was the rationale for Dr. Silber’s approach of sampling fluid until motile sperm are found; that is Dr. Finnerty’s experience as well.

Epididymal repairs are not automatically performed in the upper portion of the epididymis, but if possible at a point where motile sperm are present. If that is in the mid-epididymis or lower, that’s where the repair is performed. In Dr. Finnerty’s experience, however, it often ends up being in the upper 1/3.

Do you use a high-powered operating microscope to place the stitches?

admin — Fri, 09 Nov 2007 04:57:56 +0000

Dr. Finnerty uses state-of-the-art operating microscopes by Zeiss and Leica - the foremost manufacturers of these precision instruments in the world. These scopes have optical magnification up to 40x power, superb optical characteristics, and precision power focus and zoom capabilities.

Do you use a two-layer, “microdot” technique to connect the vas?

admin — Fri, 09 Nov 2007 04:44:19 +0000

All vasectomy reversals are performed using a two-layer technique, using extremely delicate monofilament nylon microsutures (9-0 and 10-0). The “microdot” technique places small ink dots around the inner opening, and was developed to help inexperienced surgeons place the sutures evenly and accurately. These ink dots are unnecessary when the reversal is performed by experienced microsurgeons, and may lead to an inappropriate number of sutures placed, depending on the individual patient anatomy.

Epididymal repair is also performed in two layers, using a variation of the “intussusception technique” on epididymal the tubule. This technique was developed by Dr. Finnerty to improve the precision and success rate of this difficult and delicate repair.

Do you use “conscious sedation” for the procedure?

admin — Fri, 09 Nov 2007 04:40:44 +0000

Conscious sedation is a technique where a local anesthetic is used to numb the surgical area, while drugs are given intravenously to make you relaxed and sleepy. Dr. Finnerty has extensive experience with this approach, but no longer uses it. The sedation can have unusual and unpleasant effects on a small percentage of patients, leading to restlessness, anxiety, and even breathing difficulty. When these side effects occur, the success of the surgery and your personal safety may be put at risk.

All reversal surgeries are now done under general anesthesia, administered by a board-certified anesthesiologist. This approach is extremely safe and comfortable, and affords the ideal environment for the successful performance of your reversal surgery.

How many sutures do you use?

admin — Wed, 07 Nov 2007 07:23:15 +0000

The answer is, it depends on the situation and the anatomy found at surgery. This question first arose when some surgeons using low-power optical loops began claiming they were doing “microsurgery.” The use of only a few larger sutures was the tip-off, as microsurgery uses finer and more numerous sutures.
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Pacific Grill

admin — Sat, 16 Jun 2007 07:00:38 +0000

Pacific Grill

1502 Pacific Avenue
Tacoma, Washington 98402
253.627.3535

From the moment you first step into Pacific Grill, you’ll feel welcome and comfortable.
Gracefully restored, the ground floor of the Waddell building features 17-foot high exposed beam ceilings, glowing sealife artforms, and intimate lighting. Elegant not stuffy. Soothing yet dynamic, never self-important or intimidating.

An expansive bar awaits–perfect for completing a deal, or rolling-up your sleeves after a hard day. The bartender knows you like your martini shaken - not stirred, or has your Manhattan or Side Car cocktail waiting - before you sit down. Perhaps some crisp oysters, fresh from local waters?

It speaks to great beginnings…to comfort, relaxation & romance
and great conversation.

As you are taken into the dining room–to your favorite table, the stage has been set for Chef Gordon Naccarato’s award-winning food. His classic menu is the kind of food you want everyday: A perfect steak–prepared the way he knows you like it. A great Chop. A crisp Caesar Salad. Impeccable shellfish over crushed ice…the kind of food you want to eat “right now.”

El Gaucho Steak House

admin — Tue, 05 Jun 2007 05:37:28 +0000

El Gaucho - Tacoma

2119 Pacific Ave
Tacoma WA
(253) 272-1510

There are occasions when nothing less than perfection will do. Special events so momentous, they must be marked and remembered forever. For these, there is only one choice: The spectacular El Gaucho.

The atmosphere is swank and sophisticated, the food exquisitely prepared. But the heart of the El Gaucho® experience is the legendary hospitality of Seattle restaurateur Paul Mackay. From the flambes to the table-side carving, the attentive staff will guarantee a memorable evening; one celebrated with delicious food, and presented with theatrical style and flair.

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Harmon Brewing

admin — Tue, 05 Jun 2007 05:25:33 +0000

Harmon Brewing

1938 Pacific Ave
Tacoma, WA 98402
(253) 383-2739

Located in a historic brick building from the turn of the century, in Tacoma’s renovated downtown, near Union Station, this pub & brewery offers 10 excellent home-made micro-brews and a great assortment of excellent fare such crab cakes, tasty soups and salads, and mouth-watering burgers.

Tacoma Dome Best Western

admin — Sun, 03 Jun 2007 21:18:19 +0000

Tacoma Dome Best Western

2611 East E St
Tacoma, WA 98421-1225
Phone: (800) 245-0637

Nightly rate: $98
(Must mention St Josephs Hospital for this rate.)

The Best Western Tacoma Dome Hotel is a full service, upscale, corporate hotel. Our 162 guest sleeping rooms are quiet, well appointed and designed for optimal guest comfort. Six suites are available to choose from for the corporate executive or just for a comfortable, elegant room to enjoy during your stay. You will find the Best Western Tacoma Dome Hotel conveniently located at Exit 133 off of Interstate Highway 5. Directly adjacent to the hotel is the world famous Tacoma Dome, housing major sporting events, concerts, exhibits, and conventions. The hotel is within minutes of several popular attractions, fine restaurants, and Tacoma’s city center. Also nearby are the Tacoma Mall, Point Defiance Zoo & Aquarium, waterfront shopping, and dining.