Vasectomy reversal: Microsurgical two-layer vasovasostomy

In this video, Edward Karpman, MD, shows how he performs microsurgical two-layer vasovasostomy to reconstruct the vas deferens after vasectomy.


Section Editor’s note: ‘Y’tube, a new video section of, is a resource for urologists and other clinicians who focus on men’s health. ‘Y’tube covers surgical aspects of a variety of men’s health issues with the ultimate goal of accumulating a library of videos to serve as a reference.

Microsurgical two-layer vasovasostomy is performed to reconstruct the vas deferens after vasectomy. High-power magnification (x24), the microdot technique, and fine microsurgical instruments are used to precisely anastamose the freshly cut ends of the vas deferens. Tension-free anastamosis is essential for success.

Dr. Williams: The microsurgical two-layer vasovasostomy remains the gold standard for reconstruction of the ductal system following vasectomy. Vasovasostomy is performed when sperm are found in the vasal fluid of the testicular vas deferens (or in unique cases when the obstructive interval is less than 5 years and clear watery fluid without sperm is seen). Success following this procedure is dependent on a number of factors, including having a tension-free anastomosis and, as seen in this video, precise placement of microsutures and strict adherence to meticulous microsurgical techniques.

Dr. Hotaling: Dr. Karpman illustrates many of the key principles of optimal microsurgical vasectomy reversal in this video. His use of the microdot technique to precisely space out the sutures, meticulous tissue handling of vasal mucosa, and the gold-standard two-layer technique will contribute to an optimal surgical outcome. Use of double-armed fishhook 10-0 nylon sutures allows all of the stitches to be placed from in to out, facilitating precise and optimal intraluminal needle placement.

James M. Hotaling, MD, MS, Section EditorDr. Hotaling is assistant professor of surgery (urology) at the

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