17 May 2000 Unpredictable long-term tissue effects in laser-assisted vasovasostomy
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Proceedings Volume 3907, Lasers in Surgery: Advanced Characterization, Therapeutics, and Systems X; (2000) https://doi.org/10.1117/12.386256
Event: BiOS 2000 The International Symposium on Biomedical Optics, 2000, San Jose, CA, United States
Abstract
Macroscopic Nd:YAG laser-assisted vasovasostomy was introduced to clinical practice as an attractive alternative to conventional microsurgical suture techniques. In this simple procedure the approximated vasal ends are welded by 0.5 sec laser pulses of 10 W power. The anastomosis is secured by two superficial seromuscular 5 - 0 PDS sutures placed on diametrically opposed sites of the vasal circumference. To date, 17 patients have undergone macroscopic laser-assisted vasovasostomy. In each case the operation was carried out under general anesthesia. There were no serious intra- or postoperative complications. Twelve patients were available for long-term followup (4 years). Sperm counts were obtained two months following surgery and from then on every two years. Whereas patency rate reached 75% at the first control examination, it dropped to 33% after two years. After that period no further deterioration was observed. Probably the main reason for this phenomenon is sperm leaking through mucosal defects at the anastomosis with subsequent formation of intramural sperm granuloma and delayed stenosis of the vasal lumen. This tissue reaction may also occur in the different suture techniques thus accounting for the well- established discrepancy of patency and pregnancy rates in microsurgical vasovasostomy.
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Peter T. O. Gilbert, Peter T. O. Gilbert, "Unpredictable long-term tissue effects in laser-assisted vasovasostomy", Proc. SPIE 3907, Lasers in Surgery: Advanced Characterization, Therapeutics, and Systems X, (17 May 2000); doi: 10.1117/12.386256; https://doi.org/10.1117/12.386256
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