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

Abstract Objectives To assess the feasibility of a multilayered robotic-assisted vasovasostomy (RAVV) in a rabbit model. Microscope-assisted vasovasostomy (MAVV) is a technically challenging procedure. Robotics may be a surgical adjunct that helps overcome the microsurgical challenges, which include fine suture, delicate instruments, and tremor. A recent survey revealed that most urologists use a multilayered technique for vasovasostomies. Methods A surgeon performed eight vasovasostomies with 10-0 suture and a two-layer technique using an in vivo rabbit model—four were MAVV using conventional microsurgical instrumentation and four were RAVV using the da Vinci robot. Performance measures and adverse haptic events were recorded. Patency was evaluated by passing a 2-0 Prolene suture through the anastomoses. Results The mean operating time for the total procedure and for the mucosal layer only was longer for RAVV than for MAVV (75 versus 42 minutes, P = 0.03 and 38 versus 23 minutes, P = 0.03, respectively). The needle passes required for the mucosal layer and the number of mucosal and muscularis sutures were similar in both groups (9.5 versus 8.8 passes, P = 0.34; 4 versus 4, P >0.99; and 7 versus 6.3, P = 0.2, respectively). Unlike MAVV, no tremor was appreciated during RAVV. No adverse haptic events were observed in either group. All anastomoses were patent, and all rabbits were free of any crush injury. Conclusions A multilayered RAVV can be performed in an in vivo rabbit model. Although it was associated with increased operative times, the absence of adverse haptic events and comparable patency rates continue to suggest a role for robotics in microsurgery.