Robotic Surgical Procedures For Male Infertility

The use of the operating microscope ushered in a new era in dealing with male reproductive issues. First described by Sherman J. Silber in 1975, a Zeiss operating microscope was used to fashion a two-layer vasovasostomy, achieving a higher vasal patency rate and pregnancy rate than that achieved with non-microscopic repair (Schultheiss D, Denil J, Andrologi 34(4):234–241, 2002; Silber SJ, Urology 6(2):150–153, 1975). In subsequent years the use of the operating microscope has been suggested as a valuable adjunct in several operative procedures relating to male infertility. The da Vinci® Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) provides a steady platform with multiple tool manipulation and a three-dimensional view with 10–15 times magnification. Human tremors are “filtered out” and the surgeon is in a comfortable, ergonomic position (Thiel DD, Winfield HN, J Endourol/Endourol Soc 22(4):825–830, 2008). It seems almost intuitive that the aforementioned advantages already suggested by the prior use of the operating microscope can only be enhanced by the incorporation of the surgical robot. As urological reproductive surgeons skilled in microsurgery become more familiar with the surgical robot it will also become apparent as the stability of the instrument allows them to not only see, but perform fine manipulations over extended periods of time that reduce the tremors and fatigue which “flesh is heyre to.” (Shakespeare W, Hamlet, Act III Scene 1, 1600).This chapter presents a detailed description of the surgical techniques that we have developed for robotic vasovasostomy, robotic vasoepididymostomy, robotic varicocelectomy, and robotic testicular sperm aspiration (TESE).