Robot-assisted vasovasostomy for vasectomy reversal: long-term outcomes from a high-volume tertiary centre

Vasectomy reversal is a technically demanding microsurgical procedure aimed at restoring fertility. Robot-assisted vasovasostomy (RAVV) has been introduced to enhance precision and ergonomics, but robust clinical data remain limited. We report perioperative, functional, and fertility outcomes from one of the largest single-centre series of RAVV and explore patient-related factors associated with postoperative patency. We retrospectively analysed prospectively maintained data from men undergoing bilateral RAVV at a tertiary referral centre between January 2008 and September 2025. All patients had fathered at least one biological child before undergoing vasectomy. Perioperative outcomes, semen parameters, and pregnancy rates were assessed. Functional patency was defined as a postoperative sperm concentration ≥ 1 million/mL. Associations between clinical variables and patency were explored using univariable logistic regression analyses. Sixty men underwent RAVV. Median age at surgery was 42 years (IQR 38-47), and the median interval between vasectomy and reversal was 6 years (IQR 4-9). Median operative and console times were 118 min (IQR 100-132) and 85 min (IQR 70-100), respectively. All patients were discharged on postoperative day 1. Functional patency was achieved in 56 patients (93.3%). Among 44 men attempting conception, 36 (81.8%) achieved spontaneous pregnancy during follow-up. In univariable analysis, active smoking was significantly associated with a reduced likelihood of postoperative patency. RAVV achieved high postoperative patency and favourable pregnancy outcomes in this single-centre cohort, supporting its feasibility in experienced robotic centres. Active smoking was associated with a lower likelihood of patency, although this exploratory finding requires confirmation in larger studies. Comparative studies with conventional microsurgical vasovasostomy are needed to establish the relative clinical value of the robotic approach.