Henrico Doctors' Surgeon Performs Nation’s First Robotically Assisted Vasectomy Reversal

(Richmond, VA) - Dr. Richard W. Graham of The Virginia Urology Center has performed the nation’s first robotically assisted microsurgical vasovasostomy for vasectomy reversal. The operation was performed Monday, July 15, 2002, on a 36-year-old man at Henrico Doctors’ Hospital using the da Vinci™ Surgical System.

Approximately 500,000 men choose to have vasectomies annually, and it is estimated that 5 percent of these men will ultimately desire reversal to restore their fertility due to remarriage, death of a child, or other lifestyle changes. Vasectomy reversal is a surgical procedure that restores the flow of sperm through the vas deferens. Over the past 30 years the success of vasectomy reversal has been attributed to the advent and skilled use of microsurgery, allowing the ends of the vas deferens to be rejoined more accurately. Experience in Europe shows that using the da Vinci robot adds even greater accuracy to the procedure.

The vasovasostomy, which Dr. Graham performed, is one of two surgical techniques for vasectomy reversal. The procedure joins the inner and outer layers of the vas deferens together with ultra-fine sutures. After making a small incision in the scrotal skin over the vasectomy site, Dr. Graham locates the disconnected ends of the vas deferens. Using a two-layer closure, Dr. Graham places sutures in the mucosa, or inner layer of the vas, to ensure complete closure of the area. Next, Dr. Graham reconnects the muscular layer and the surrounding connective tissue. The scrotal incision is then closed.

The lumen, or channel through which the sperm travel, is only 0.2 to 0.3 millimeters in diameter, about the size of a pinpoint. The diameter of the vas deferens is barely visible to the human eye (0.3 to 0.5 millimeters in diameter). The da Vinci System’s precision is particularly beneficial in surgical cases such as vasectomy reversal in that it provides adjustable motion scaling in which the surgical instrument movement is scaled down to 1/5 the movement of the surgeon’s hand-allowing more precise manipulation and stitching and elimination of tremor. These highly specialized instruments seamlessly translate the surgeon's natural hand movements at a console into corresponding micro-movements of the instruments. In addition, the da Vinci provides a three-dimensional, color view of the operating field, including necessary depth perception for manipulating delicate tissue layers.

Also, in standard, two-dimensional laparoscopic surgery, the full-scale movement of the instruments is "counter-intuitive," similar to doing surgery while looking in a mirror. The da Vinci System is the only way to do laparoscopic surgery "intuitively": the surgeon twists the control clockwise and the robot’s instruments twist clockwise, giving the surgeon natural hand-eye coordination.

"Leakage of sperm from the vas surgical site may cause inflammation and subsequent blockage, perhaps the biggest reason that vasectomy reversals fail," Dr. Graham explained. "Clearly, the placement of sutures with the aid of motion scaling and optimal magnification ensures the most precise technique and successful outcome." Dr. Graham is highly optimistic that by using the da Vinci Surgical System complications of vasectomy reversal such as anastomotic leaks can be markedly reduced. "The da Vinci System provides much greater control over the instruments," he continued, "thereby significantly improving our precision and outcome."

The Vasovasostomy Study Group, the largest multicenter group to assess vasovasostomy efficacy, reports that one of the most important factors is the microsurgical experience level of the surgeon. A urologist who performs the procedure without any magnification (i.e., the so-called macroscopic vasovasostomy) has significantly worse surgical results with pregnancy rates ranging from 19-55%. When the microsurgical technique is used, the success rates are markedly improved.

Dr. Graham is considered a pioneer in the field of robotically assisted urological microsurgery. In July of 2000, Dr. Graham became the first urologist in the world to perform surgery to treat urinary incontinence using the da Vinci Surgical System. In addition, he has perfected da Vinci System use for numerous other urological disorders including kidney removal, ureter stone removal, kidney cyst removal, and ureter resection. In November of 2000, Dr. Graham performed the nation’s first radical prostatectomy with the da Vinci robot.

Henrico Doctors’ Hospitals’ campuses at 1602 Skipwith Road (Forest Campus) and 7700 E. Parham Road (Parham Campus) together form one of the largest and most advanced acute care facilities in Central Virginia. Henrico Doctors’ Hospitals provide innovative and world-class health care, typically found at a university medical center, delivered in a community hospital setting.

For further information, you may contact Dr. Graham at The Virginia Urology Center at (804) 288-4137 (please ask for Janece).