The use of a microscope means smaller incisions, which means less tissue trauma. The microsurgical approach involves a single midline, or two-5mm “keyhole” small scrotal holes, similar to when the initial vasectomy was performed (but often smaller in reversal surgery as done by a microsurgeon while initial vasectomy often done using scalpel or scissors). *See photos further down page.
The previous vasectomy site is dissected with the dead scar tissues removed (we don’t leave lumpy tissues behind), the tied-off part identified and excised, the ends refashioned, and patency of each lumen tested.
The vas openings, which have a diameter less than ½ a millimetre, are re-joined in two overlapping layers using a microscope, achieving an equivalent water-tight seal effect with sutures that are hardly visible to the naked eye (magnified under operative microscope up to 40x of normal vision) with very fine 8-9 O sutures, without the use of clamps (so as to minimise tissue handling and trauma).
Either a single midline, or occasionally two 5mm “keyhole” small scrotal incisions are made to gain access to the vas deferens. After healing, the surgical incision is almost invisible. Below shows Dr Lok’s single midline incision where he performed vasectomy reversal on a patient.
Using the aid of a powerful microscope, vasectomy reversal surgery can be performed through a small keyhole with great accuracy when performed by an experienced surgeon. This is advanced microscopic surgery and the evidence shows that experience does result in improved surgical outcomes for patients.
Example of another doctors’ post surgical scaring from ‘open surgery’ technique, which failed, when compared to Dr Derek Lok’s keyhole vasectomy reversal surgery he performed on the patient to correct previous failure from elsewhere.
The Vasovasostomy (vasectomy reversal) Study Group (ASRM) also found that with meticulous microsurgical techniques sperm appears in the semen of 85-90% of men and 50-70% of their wives become pregnant; while with less ideal approaches (eg: open surgical approach) even when sperm appears in the semen of about 80% of men, only 20-40% of their wives conceive.
The experience of your surgeon matters:
The success rates of vasectomy reversal correlates with the operative frequency. A number of studies reported that surgeons who operate at high frequency of >= 15 vasectomy reversals per year reached a cumulative patency rate of 70% and a pregnancy rate of 33%; while those operate with a comparably low frequency of <= 6 cases per year obtained a cumulative patency rate of 45% and a pregnancy rate of 8.8% only.
Seven published series on vasectomy reversal surgery, that included a total of 2,330 patients who were available for follow-up, showed an average patency rates of 88% and pregnancy rate of 62%.
Dr Derek Lok’s own audit of 120 male patients operated on over 3-years, with follow-up for up to 3-years, has demonstrated the presence of sperm in the ejaculate following surgery in 90% of patients.
The increase in pressure, which results from tying off the vas, is transmitted to the much finer and thin walled duct, which attaches to the vas called the epididymis (around 6 meters long). After variable periods of time (about 10-15 years following original vasectomy), the dilatation may cause a rupture or a “blowout” of the duct leading to a blockage.
Because it is a single duct, sperm will no longer reach the site where vasectomy was performed. Re-joining the vas under these circumstances will not be successful as the rupture site(s) are difficult to identify and often bilateral. Ruptures rarely cause symptoms and are not easily diagnosed by examination or imaging.
Finding the spontaneous flow of fluid when the vas is open at reversal is a good but not absolute prognostic sign for a successful outcome. The presence of live sperm in the fluid of the opened vas is the best finding for success.
The Vasovasostomy Study Group (ASRM) found that in 1,247 patients the patency and pregnancy rates to be 97% and 76% if the obstructive interval was less than three years, 88% and 53% if three to eight years, 79% and 44% if nine to 14 years, and 71% and 30% if 15 years or longer.
Particularly in the first two years after vasectomy it is not unusual to find the presence of “antibodies” to sperm in blood tests. When persistent in high levels in later years they may interfere with sperm function by causing sperm to clump or stick together following ejaculation thus interfering with their ability to fertilise oocytes (the female’s eggs).
Tests on ejaculated sperm give the best indication of the significance of sperm antibodies and overall their presence is not a contraindication to surgery, as often antibody levels drop once the continued leakage or challenge to immune system is eliminated after flow restored by reversal surgery. Hence the majority of reversal surgeons are not currently carrying out antibody tests before surgery.
A payment is required 2 weeks prior to the date of your operation to confirm your place on Dr Lok’s operating list (or at the time of confirmation of date of surgery if booking is made less than 2 weeks before your operation).
A cancellation fee of $500 is payable for cancellation of surgery less than 2 weeks prior to the date of operation. This amount will be refunded if a future booking for surgery is made.
Dr Lok has 2 operative lists a week, including some Sat, and will be able to fit you in within a week or
Two of your choice, in one of the following Hospitals:
Sydney City at Genea Day Surgery: Level 4, 321 Kent St, Sydney
Strathfield Private Hospital
Sydney South at South West Private Hospital
If you have a question or enquiry related to vasectomy reversal surgery, please get in touch and we will get back to you.