Innovative single-armed suture technique for microsurgical vasoepididymostomy
Innovative single-armed suture technique for microsurgical vasoepididymostomy
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DOI：
10.1016/j.urology.2007.01.091
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发表时间：
2007-04-01
期刊：
影响因子：
2.1
通讯作者：
Goldstein, Marc
中科院分区：
文献类型：
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作者：
Monoski, Mara A.;Schiff, Jonathan;Goldstein, Marc
目的附睾管吻合术的效果在很大程度上取决于外科医生的显微外科经验和技能。为了避免管腔后壁，通常使用双臂微缝线将针从内向外穿过血管管腔放置。这些用于不孕症显微手术的双臂缝合线非常昂贵，而且可能很难获得。我们描述了一项随机试验，该试验使用了一种新的单臂缝线放置模式来吻合附睾管。2周后，采用单臂纵行套叠血管附睾造口术(n=6)或标准双臂纵行套叠血管附睾造口术(n=6)进行附睾管吻合术。9周后，通过评估吻合口远端的可活动精子来评估通畅性。结果双臂吻合组通畅率为100%(6/6)，单臂吻合组通畅率为83.3%(5/6)。差异无统计学意义(P=0.50)。双臂组6个吻合口中有3个(50%)出现精子肉芽肿，单臂血管附睾组6个吻合口中有5个(83%)出现精子肉芽肿(P=0.27)。双臂和单臂纵向套叠附睾管吻合术的平均手术时间相似(分别为35min和43min，P=0.39)。结论本研究结果表明，单臂缝合技术与双臂缝合技术的效果基本相同。虽然我们仍然倾向于使用双臂缝线，但我们认为，在没有专门的双臂缝线的情况下，这是一种实用而有效的选择。泌尿外科69：800-804,2007。(C)2007年爱思唯尔公司。
OBJECTIVES Vasoepididymostomy outcomes are heavily dependent on the surgeon's microsurgical experience and skill. To avoid back-walling the tubular lumen, the needles are generally placed inside-out through the vasal lumen using double-armed microsutures. These double-armed sutures for infertility microsurgery are very expensive and may be difficult to obtain. We describe a randomized trial that used a novel single-armed suture placement pattern for vasoepididymostomy.METHODS Male adult Wistar rats underwent vasectomy. Two weeks later, vasoepididymostomies were performed using either a single-armed longitudinal intussusception vasoepididymostomy (n = 6) or a standard double-armed longitudinal intussusception vasoepididymostomy (n = 6) technique. After 9 weeks, patency was assessed functionally by evaluating for motile sperm distal to the anastomosis. If no motile sperm were visible, the mechanical patency of the anastomoses was tested by the ability of methylene blue to pass through the surgical anastomosis.RESULTS The patency rate for the double-armed vasoepididymostomy group was 100% (6 of 6) compared with 83.3% (5 of 6) for the single-armed vasoepididymostomy group. This difference was not significant (P = 0.50). Sperm granulomas were found in three (50%) of six anastomoses in the double-armed group and five (83%) of six anastomoses in the single-armed vasoepididymostomy group (P = 0.27). The mean operative times for the double and single-armed longitudinal intussusception vasoepididymostomy techniques were similar (35 minutes versus 43 minutes; P = 0.39).CONCLUSIONS The results of our study have shown that the single-armed suture technique to perform vasoepididymostomy is almost as effective as the double-armed technique. Although we still prefer to use double-armed sutures, we believe that this is a practical and effective alternative when specialized double-armed microsurgical sutures are not available. UROLOGY 69: 800-804, 2007. (C) 2007 Elsevier Inc.