Study: Rebound from vasectomy reversal quicker in hands of robot
The robot-assisted procedure cut 20 minutes off the time spent in surgery, and sperm count rebounded quicker.
Published: Tuesday, January 12, 2010 at 6:01 a.m.
Last Modified: Monday, January 11, 2010 at 11:12 p.m.
Cutting 20 minutes off the time spent in surgery to reverse a vasectomy might not seem like much. But to a couple trying to get pregnant, it can be a very big deal.
That's the view of Dr. Sijo Parekattil, director of male infertility and microsurgery at the University of Florida.
Parekattil recently completed a year-long study looking at the time needed to perform vasectomy reversal using robot-assisted surgery compared with conventional surgery in which the surgeon is aided by a microscope.
Sperm count after surgery is comparable over a year for the two procedures, according to the UF study, but the robotic procedure appears to result in a quicker rebound for sperm count.
The findings, to appear in an upcoming print edition of the Journal of Endourology, represent the first head-to-head comparison of robot-assisted vasectomy reversal and the microscope procedure that is widely used.
Many types of surgery are being aided by robots, and surgeons continue to explore new areas in which they can be used.
"This is state-of-the-art stuff. It's cutting-edge and a stepping stone to understanding whether or not we can use this technology on a more widespread basis," said Dr. Wayne Kuang , director of Male Reproductive Health at the University of New Mexico. Kuang was not involved in the study.
"It's a natural progression from back in the days when we [surgeons] just had magnified eyeglasses," he said.
The procedure to reverse vasectomies using vasovasostomy, a form of microsurgery, was first performed in 1971. Vasovasostomy is effective at achieving pregnancy in 50 percent to 70 percent of cases, but it is costly, with total out-of-pocket costs in the United States of approximately $7,000.
Most patients pay out of pocket for vasectomy reversal. The robot-assisted procedure can cost more than $3,000 more than the microscope method.
Some specialists in the field have questioned whether using an expensive robot to do something that already is done well simply with a microscope is a waste of resources.
"The big question is did it improve outcomes - either pregnancy rates or the time spent in surgery?" said Dr. Jay Sandlow of the department of urology at the Medical College of Wisconsin in Milwaukee.
Since many hospital fees are based on time, cutting operating time might offset some of the extra charges associated with the use of the robot.
Parekattil, who is fellowship-trained in both infertility microsurgery and robotics, suspects that the time reduction happens because the robot allows for more efficient use of instruments with the use of multiple arms and tools simultaneously.
It is too soon to tell whether pregnancy rates have improved since the mid-2009 conclusion of the one-year study in which 20 men had the robotic procedure and seven had the microscopic one.
But two months after surgery, average sperm count in the robotic surgery group was 54 million, compared with 11 million in the microscopic surgery group.
Early results show that the difference in sperm count between the two procedures decreases over time, however.
Despite the study's small sample size, physicians say it is promising and requires more evaluation and longer follow-up of patients to yield more widely applicable results.
"I don't think there's going to be a huge change in practice," Sandlow said.
"But in academia part of what we do is try to push the envelope and try to see what works and what doesn't - and it's through studies like this that we answer those questions," he said.
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