ABSTRACT
Microsurgical technique, with separate mucosal and muscular layer anastomosis, recently has been advocated as the most successful method of vasovasostomy. Unexpected difficulties may be encountered using this method; moreover, considerable practice in the microsurgical laboratory is mandatory before actual performance of the procedure. As with any innovation in surgical technique, a judgment of the clinical superiority of the two-layer anastomotic method must await substantiating results from other investigators.
PIP: A microsurgical technique, with separate mucosal and muscular layer anastomosis, has been advocated as the most successful vasovasostomy method presently available. But the 2-layer microsurgical vas anastomosis has aspects that are foreign both to the urologist and to the experienced microvascular surgeon, and suggestions are made for mastering this microtechnique. For the urologist, practice on sheet rubber edges followed by vessel anastomosis in small animals are prerequisite to successful surgical outocme. For the microvascular surgeon, certain changes must be made from usual practices because of the stiffness, thickness of wall, and small size of lumen compared with the outer diameter of vas deferens. A summary of attempts made at 2-layer anastomosis suggests that the 2-layer method in a laboratory model appeared superior to a single-layer method. Final judgement of superiority of this 2-layer technique cannot be pronounced.
