How Much Individual Surgeon Experience is Necessary?
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Although the type of microsurgical technique is not critical to success, what is universally recognized as important is the degree of experience of the individual microsurgeon. The obvious question is what amount of experience is required? This simple question does not have an answer solidly based on surgical science, however, I am aware of one paper that attempts to approach the issue.
Dr. Nagler, in a 2002 review, published the results of a survey he and Dr. Arnold Belker performed. These two well known authors and experts in the field of vasectomy reversal surgery conducted the survey to evaluate the performance of a group of urologists who had participated in a microsurgery course. They found that those surgeons who performed microscopic vas reversal without additional laboratory practice had only a 53% patency rate, compared with an 89% patency rate for those surgeons who practiced their microsurgical skills in the laboratory before using them clinically for patients. The authors concluded the survey demonstrated the need for surgeons who participated in a microsurgery course to practice microsurgery in the laboratory before conducting it in a clinical setting.
It is interesting to note the 89% patency rate described in the survey is similar to the 86% patency rate the five expert microsurgeons achieved on first time procedure patients in the Vasovasostomy Study Group. Therefore, it is reasonable to conclude that a surgeon who has completed a microsurgical course and then practiced in the laboratory has obtained sufficient experience to perform vasectomy reversal in the clinical setting.
Impact of anesthesia:
Usually a light general anesthetic (we put you to sleep) combined with the use of a local anesthetic to "numb" the area where the surgery is occurring, much like at the time of the original vasectomy. It is important to also note the same five center study group involving over 1400 microsurgical patients found no significant difference in results between patients who had local anesthesia and those who had general anesthesia. Most first time procedures were done with local anesthesia.
Cost:
Yes, it really is $1,500 paid by check or cash. The total cost for the microscopic reversal done in the office under local anesthesia with minimal preoperative oral sedation is an all inclusive $1,500. No credit cards are accepted. There are no other fees outside of the $1,500.
Success Rate:
The success rate varies depending on the type of reconnection (vasovasostomy or epididymovasostomy) that is required. This can only be determined at the time of surgery. However, where a straight forward vasectomy reversal (VV) can be performed on both sides, regardless of the number of years since the vasectomy, sperm return in 95 % of our cases, with a corresponding 65 % pregnancy rate. (Please note that of all couples trying to conceive, only 85 % will achieve a natural conception at the end of one year). When a bypass to the epididymis (EV) is required on both sides due to a secondary blockage or “epididymis blow-out,” we still achieve return of sperm in 80 % of such cases, with a corresponding 50 % pregnancy rate. Since nearly one half of our cases are complicated redo cases of previously failed vasectomy reversals from other surgeons, our overall statistics are 89 % for return of sperm and 55 % pregnancy rate, with an average of 11.5 years from time of vasectomy to time of reversal.
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