Department of Microsurgery, Andrologie Centrum München, München, Germany.
Nat Rev Urol. 2013 Apr;10(4):195-205. doi: 10.1038/nrurol.2013.14. Epub 2013 Feb 12.
Vasectomy reversal is the most common microsurgical intervention for the treatment of male infertility. Originally introduced in 1977, microsurgical vasectomy reversal has become highly sophisticated and is a minimally invasive, highly efficient and cost-effective treatment option for men with a desire to have children after vasectomy. It can be an effective physiological method of restoring fertility in more than 90% of vasectomized men. Although assisted reproductive technology (ART) is an alternative to vasectomy reversal, it is normally associated with higher costs without offering higher cumulative chances of a pregnancy. Recovery of physiological male fertility can take up to 2 years after vasectomy reversal, especially if reversal is performed >10 years after vasectomy, owing to impaired epididymal function. Under these circumstances, ART can be used to bridge the time until recovery of natural fertility. Although the basic principles of microsurgical vasovasostomy have been established since the late 1970s, there have since been numerous technical innovations to improve the delicate operation and promising new technical modifications, particularly for vasoepididymostomy, have been described. Robotic vasectomy reversal is an emerging field in specialized urologic centers, but whether the high quality of conventional microsurgical vasectomy reversal can be matched by robotic platforms is yet to be seen.
输精管复通术是治疗男性不育症最常见的显微外科手术。该手术最初于 1977 年被引入，经过多年发展，现已成为一种高度复杂的微创手术，为有生育需求的男性提供了一种微创、高效、经济有效的治疗选择。对于输精管结扎后的男性，输精管复通术可有效恢复生育能力，成功率超过 90%。虽然辅助生殖技术（ART）是输精管复通术的替代方案，但它通常与更高的成本相关，而不会提供更高的妊娠累积几率。输精管复通术后，男性的生理生育能力需要长达 2 年才能恢复，尤其是在输精管结扎 10 年以上后进行复通术，因为此时附睾功能受损。在这种情况下，ART 可以用于填补自然生育能力恢复前的时间空白。尽管自 20 世纪 70 年代末以来，显微输精管吻合术的基本原理已经确立，但此后已经有许多技术创新来改进这一精细手术，并且已经描述了许多有前途的新技术改良方法，特别是在输精管附睾吻合术方面。机器人输精管复通术是专门的泌尿科中心新兴的领域，但机器人平台是否能够匹配传统显微输精管复通术的高质量，仍有待观察。
