Robot-assisted vasovasostomy and vasoepididymostomy: Current status and review of the literature

Objective: Microscope-assisted vasovasostomy (MAVV) is a standard procedure used to reverse vasectomies. Robotic surgery has been established primarily for technically demanding urological procedures and has also been recently implemented in male reproductive surgery. We aimed to review the current evidence of robot-assisted vasovasostomy (RAVV) and robot-assisted vasoepididymostomy (RAVE). Material and methods: We performed a systematic literature review using PubMed to identify relevant original articles. We identified 2017 records through database search, and after removing duplicates, 782 records remained for further analysis. Results: In total, 12 human and three animal studies were selected. Reported vasal patency rate ranges were 88%-100% for RAVVs and 55%-61% for RAVEs. The sperm count and postoperative pregnancy rates of RAVV ranged between 8.4 x 10(6)-120 x 10(6) sperm/mL and 65%, respectively. Finally, procedure times in the human studies, recorded for extracorporeal RAVVs and RAVEs ranged from 97 to 238 minutes. Conclusion: Robot-assisted vasal reversal is feasible with similar patency rates as for the microsurgical approach and showing comparable outcomes. Additional benefits of this technique include improved vision and movement precision.