Robotic-assisted vasovasostomy: a two-layer technique in an animal model

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Robotics

Background:

• Microsurgical vasovasostomy is technically demanding, requiring fine sutures and precise instrument handling.
• Robotic systems may offer advantages in microsurgery by mitigating tremor and enhancing dexterity.
• A multilayered technique is commonly employed for vasovasostomies.

Purpose of the Study:

• To evaluate the feasibility of performing a multilayered robotic-assisted vasovasostomy (RAVV) in a rabbit model.
• To compare RAVV with conventional microscope-assisted vasovasostomy (MAVV) in terms of operative time, suture requirements, and anastomotic patency.

Main Methods:

• Eight vasovasostomies were performed in rabbits using 10-0 suture and a two-layer technique.
• Four procedures utilized MAVV with conventional microsurgical instruments.
• Four procedures employed the da Vinci robot for RAVV.

Main Results:

• RAVV demonstrated longer mean operative times compared to MAVV (75 vs. 42 minutes overall; 38 vs. 23 minutes for the mucosal layer).
• The number of needle passes and sutures for the mucosal and muscularis layers were similar between RAVV and MAVV.
• No tremor or adverse haptic events were observed during RAVV, and all anastomoses were patent with no crush injury.

Conclusions:

• Multilayered RAVV is feasible in an in vivo rabbit model.
• RAVV, despite increased operative time, offers potential benefits in microsurgery due to the absence of tremor and comparable patency rates.
• Robotics may serve as a valuable adjunct for complex microsurgical procedures like vasovasostomy.