Ex vivo feasibility study of vasovasostomy utilizing a novel microsurgery platform versus manual microsurgery

The use of the microsurgical vasovasostomy technique allows for greater precision and the use of extra-fine sutures, resulting in improved outcomes for vasectomy reversal procedures. The challenging nature of these microsurgical procedures has led to the investigation of robotic-assisted microsurgical vasovasostomy for decreased hand tremor and increased dexterity and hand-eye coordination. To date, no research has investigated vasovasostomy using the Symani Surgical System, a robotic device approved by the US Food and Drug Administration (FDA) for microsurgical procedures. This study investigated the feasibility of using the Symani Surgical System to perform vasovasostomy for vasectomy reversal.

In this prospective, controlled study, three surgeons performed vasovasostomy anastomoses on sections of Ovis aries (sheep) vas deferens and sections of synthetic vas deferens segments. Ten sutures were completed for each anastomosis. The interventional surgeries were robot-assisted and performed using the Symani Surgical System, while the control surgeries were performed using the manual microsurgical vasovasostomy technique. All vasovasostomies were performed in a double-layer technique using 9/0 nylon and 10/0 nylon sutures. Outcomes included the net time for each suture placement and knot tie (seconds), the number of suture breaks, and the quality of the anastomosis as measured by a leak test.

Three surgeons performed a total of 9 Ovis aries vasal anastomoses, with 5 robot-assisted and 4 manual anastomoses performed. The duration of the mean net suture time for the robotic platform was significantly longer than the mean net suture time for manual surgeries (104 vs. 72 s; P=0.03). However, an evident learning curve with the robotic surgery platform showed a rapid decrease in anastomosis times with each subsequent surgery, for each surgeon. There were no suture breaks during robotic microsurgery and 5 suture breaks during manual microsurgery (P=0.02). Mean leak scores were similar. One surgeon performed 12 anastomoses on synthetic vas segments, and again, the mean net suture time for the robotic platform was significantly longer than the mean net suture time for manual microsurgeries (96 vs. 74 s; P=0.03). For the synthetic vasal anastomoses, the learning curves for the robotic platform and manual microsurgeries were similar and showed an overall decrease in anastomosis times. No significant differences were observed in suture breaks or mean leak scores for the synthetic vas surgeries.

This study demonstrates that vasovasostomy can be successfully performed using the Symani surgical platform, with patency outcomes comparable to manual microsurgery as measured by measurement of anastomotic leaks, as well as technical advantages such as improved instrument stability as measured by number of suture breaks. Further research on the use of this surgical platform for vasovasostomy is warranted.