title: Mini-incision vasectomy reversal using no-scalpel vasectomy principles: efficacy and postoperative pain compared with traditional approaches to vasectomy reversal.
abstract: OBJECTIVE
  To evaluate the efficacy and postoperative morbidity of a mini-incision vasectomy reversal (MIVR) using no-scalpel vasectomy principles compared with traditional incisional approaches to vasectomy reversal (VR).
  
  
  METHODS
  Of 164 patients undergoing consecutive VR, 139 underwent bilateral vasovasostomy (55% bilateral MIVR, 24% mixed MIVR/traditional incision VR, and 21% bilateral traditional incision VR). The MIVRs were performed using a subcentimeter incision after the vas deferens was captured and delivered through the skin using the no-scalpel vasectomy principles and instruments. Semen analyses were obtained at 3-month intervals postoperatively until pregnancy was achieved. Motile sperm in the ejaculate after VR defined patency. Pain and functional recovery after surgery were evaluated using a previously validated 10-point pain scale adapted to VR. The no-scalpel vasectomy patients served as controls for the postoperative pain assessments.
  
  
  RESULTS
  The median follow-up was 11.6 months. The patency rate was 96%, 100%, and 91% for the MIVR, mixed MIVR/traditional incision, and bilateral traditional incision VR, respectively (P = .4). The semen parameters did not significantly differ among the VR approaches. The pain severity during the first 48 hours after surgery was significantly less (P < .05) for the patients who had undergone bilateral MIVR than for the patients who had undergone traditional incision VR and did not significantly differ from that of the men who had undergone no-scalpel vasectomy. The patients returned to normal activities an average of 2 days earlier after MIVR than after traditional incision VR.
  
  
  CONCLUSIONS
  The results of our study have shown that MIVR does not compromise patency outcomes or semen parameters compared with more traditional approaches to VR and results in less pain during the early period of recovery after surgery and quicker functional recovery.
authors.affiliation: Division of Urology, Mount Sinai and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada. egrober@mtsinai.on.ca
authors.forename: Ethan D
authors.initials: ED
authors.lastname: Grober
authors.forename: Keith
authors.initials: K
authors.lastname: Jarvi
authors.forename: Kirk C
authors.initials: KC
authors.lastname: Lo
authors.forename: Eyun-Jung
authors.initials: EJ
authors.lastname: Shin
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis; D055101:Semen Analysis; D013076:Sperm Count; D014669:Vasovasostomy / Q000009:adverse effects / Q000379:methods*