Vasovasostomy (Vas-to-Vas Repair)
When there is no obstruction in the epididymis, and sperm are present in the fluid at the vasectomy site, a vas-to-vas repair is performed. The scar tissue and scarred vas from the vasectomy are first excised, until healthy vas with good blood supply is present at both ends. The ends of the vas are then secured in a specialized clamp, which holds them in place with both ends pointing upward for maximum visibility.
Several sutures of fine monofilament nylon (9-0) are placed in the muscle layer of the back wall, to secure the two ends together and stabilize the repair, while leaving the lumen visible. Notice the difference in diameter between the lumen on the right, the testicular side, which is several times larger, and the smaller lumen on the left, which is the normal diameter. This is a result of the obstruction from the vasectomy.
The back wall of the lumen, the mucosal layer, is sewn next, placing two or three finer nylon sutures (10-0). This begins the inner layer repair while preserving the visibility of the lumen.
The sutures on the front (anterior) side of the mucosal layer are pre-placed before tying, allowing greater precision while preserving visibility of the lumen.
Once these anterior sutures are tied, the inner mucosal layer is approximated with great precision, leaving no openings where sperm can leak through.
Finally, the anterior muscular layer is closed with 9-0 nylon, providing additional strength and reinforcing the more delicate inner layer.
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