Epididymovasostomy (LIVE - Longitudinal Intussuception VasoEpididymostomy Technique)

In those cases where sperm are NOT identified in the testicular vas deferens, an epididymovasostomy or "bypass" operation is required. The typical appearance of the epididymis many years after the vasectomy procedure.

A single tubule from the epididymis is isolated for the reverse vasectomy procedure. This procedure can only be accomplished under the highest magnification and the patient laying completely still under a general anesthetic. Two microsurgical 10-0 Nylon sutures are passed through the single epididymal tubule along the longitudinal axis of the epididymal tubule, prior to opening the tubule.

The abdominal end of the vas deferens is re-approximated to the serosal edge of the tunic of the epididymis. The attachment of the vas deferens to the tunic of the epididymis secures the vas deferens and allows for accurate placement of the inner mucosal sutures.

The microsurgical 10-0 Nylon sutures are passed through the mucosa of the vas deferens in their corresponding locations on the mucosa of the vas deferens.

The 10-0 Nylon sutures are tied creating a water-tight closure between the epididymal tubule and the mucosa of the vas deferens. The single epididymal tubule is pulled (intussucepted) into the lumen of the vas deferens.

Additional microsurgical sutures are placed between the tunic of the epididymis and the outer (serosal) edge of the vas deferens. The additional microsutures on the outer layer of the vas deferens relieve the tension off of the important inner luminal sutures.

The final appearance of the vas deferens attached to the epididymis at slightly lower magnification. The "bypass" procedure restores continuity of sperm flowing through the vas deferens when an obstruction or "blockage" is identified at some part of the epididymis.