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達文西機器手臂輔助輸精管吻合術-單一外科醫師手術經驗以及個案分析
鄭百諭、吳維哲、鍾旭東
亞東紀念醫院 外科部 泌尿科
Robotic assisted vasovasostomy - experience and case analysis from single surgeon
Pai-Yu Cheng, Wei-Che Wu, Shiu-Dong Chung
Divisions of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
 
Purpose: Microscope assisted vasovasostomy(MAVV) has been adapted as the standard procedure for vasectomy reversal. However, the challenges of hand stability, fine suture technique and minimized tissue damage set a barrier for surgeon who is new practitioner in this field. As DaVinci system was used widely in urological surgery, robotic assisted vasovasostomy(RAVV) was published as an alternative procedure for its better view and dexterity. Here we shared our initial experience and patient outcomes, investing the feasibility of this surgery.
Materials & Methods: From Aug 2018 to Aug 2019, 5 cases received RAVV by single surgeon who performed at least 15 cases of MAVV in our hospital. One layer suture with 9-zero nylon was performed in all cases. Patency was evaluated by instilling saline through the anastomotic sites during surgery. Semen analysis was performed postoperatively within two months.
Results: All cases are in middle age, and the mean operating time was 150 minutes(Table 1). One case received MAVV two years ago but had zero sperm count post surgery, and the other four cases were the first time for reversal. Patency was all confirmed during surgery. Sperm was visualized in four cases, but was not seen in the case who received MAVV previously. Smooth learning curve compared RAVV to MAVV was reported by surgeon. Wound infection was found in one case, which improved after antibiotic treatment for one week.
Conclusion: DaVinci system appears to be safe and effective when applied in vasectomy reversal, with smooth learning curve and favorable outcome.
 
Table 1. The cases series of robotic assisted vasovasostomy
No.
Age
Operative time
(minutes)
Postoperative Semen analysis
Complication
Volume
(mL)
Appearance
pH
Motility
(%/hr)
Morphology
(%)
Sperm count
(106/mL)
WBC
(/HPF)
1
51
180
1
White
7.2
5
80
3
0-1
Nil
2
51
120
5
White
7.2
0
30
1
0-1
Nil
*3
44
180
2.5
White
7.2
0
0
0
3-5
Nil
4
42
90
2.5
White
7.4
90
100
70
1-3
Nil
5
34
180
3
White
7.8
30
85
2
1-3
Wound infection
*Received MAVV before but failed
 
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    發表人
    TUA人資客服組
    單位
    台灣泌尿科醫學會
    建立
    2020-06-11 09:50:11
    最近修訂
    2020-06-11 09:50:55
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