Are Robotic Vasectomy Reversals Any Better than Standard Vasectomy Reversals?

This review, by international vasectomy reversal author, surgeon and authority Sheldon H. F. Marks, MD, addresses many of the issues and common misconceptions about robotic vasectomy reversals, now updated in January 2023.

This is a common question as many urologists use robot-assisted techniques for kidney and prostate surgery (1). When it comes to vasectomy reversal success rates, the robot does not provide any better results or higher reverse vas success rates than a well-performed microsurgical vasectomy reversal by hand. Bottom line, the use of the da Vinci brand or any surgical robot does not provide any advantages over a state-of-the-art vasectomy reversal by a skilled, experienced true expert(2).

In fact, this very subject was a topic of conversation at a recent international urology and male fertility conference. The expert consensus, by the world’s top vas reversal doctors, was that this advanced robot technology does not make a doctor a better vasectomy reversal surgeon or give the patient any better reverse vasectomy results. If the doctor is skilled and experienced at microsurgical vas reversals (which is what patients all should be looking for) then there is no reason to think that by simply performing the surgery with a robot that they will be any better (3).

The results from a robot-assisted vas reversal are no better than a skilled vasectomy reversal. In our practice, we recently published a paper showing that we can achieve a 99.5% success for vas-to-vas connections with most patients (4). No one can get much better than that, with or without the robot.

There are a few top and respected urologists that specialize in using the robot so this is how they perform many of their vas reversals. Plus, these few experts have the experience to have moved past the dreaded “learning curve,” where many other doctors are still in that early phase of their training where their results are not as good as they will be with more time and years of additional experience (5).

There are some situations where the robotic assisted vasectomy reversal makes sense, such as after a deeper abdominal surgery, deep inguinal or pelvic vasectomy (6). When we are concerned about a potential patient who has had a prior vasectomy in the groin or laparoscopically in the abdomen, we generally refer these patients to these highly trained robotic vas reversal doctors.

This reminds me that over the decades doctors often use the phrase that might apply – “a technology looking for a use” to describe what happens when we have access to new and exciting technologies – such as laser, and now the robot. But simply having or using these new technologies does not always mean improved results.

So, for now, the key to getting the highest vas reversal success rate is to seek out the most experienced and skilled urologic micro-surgeon to perform the vasectomy reversal.

If there are any questions about what makes our full-time, vas reversal only “center of excellence” the destination of choice for more than 7000 men from every state in the US and more than 85 countries around the world, call us at (888) 722-2929 .

We are happy to talk about each patient’s specifics and set up a no charge, no obligation consultation with one of our two reversal microsurgeons in person, by phone, Zoom, Face Time or Skype.

This page was reviewed, edited and updated January 1, 2023, by Sheldon H. F. Marks, MD.

References:
1.Brahmbhatt JV, Gudeloglu A, Liverneaux P, Parekattil SJ. Robotic microsurgery optimization. Arch Plast Surg. 2014 May;41(3):225-30.
2.Parekattil SJ, Gudeloglu A, Brahmbhatt J, et al. Robotic assisted versus pure microsurgical vasectomy reversal: Technique and prospective database control trial. J Reconstr Microsurg. 2012; 28:435–44.
3. Kavoussi PK. Validation of robot-assisted vasectomy reversal. Asian J Androl. 2015 Mar-Apr;17(2):245-7.
4.Crosnoe LE, Kim ED, Perkins AR, Marks MB, Burrows PJ, Marks SH. Angled vas cutter for vasovasostomy: technique and results. Fertility and Sterility.2014;101(3):636-639.
5.Kavoussi PK, Harlan C, Kavoussi KM, Kavoussi SK. Robot-assisted microsurgical vasovasostomy: the learning curve for a pure microsurgeon. J Robot Surg. 2018 Oct 31.
6.Trost L, Parekattil S, Wang J, Hellstrom WJ. Intracorporeal robot‐assisted microsurgical vasovasostomy for the treatment of bilateral vasal obstruction occurring following bilateral inguinal hernia repairs with mesh placement. J Urol. 2014;191:1120‐1125.