Seth Ishith, Gibson Damien, Bulloch Gabriella, Joseph Konrad, Cevik Jevan, Qin Kirby R, Shahbaz Shekib, Rozen Warren M
Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, Australia.
Department of Surgery, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia.
Andrology. 2024 May;12(4):740-767. doi: 10.1111/andr.13543. Epub 2023 Oct 7.
Vasovasostomy is a cost-effective procedure for the reversal of vasectomy. A water-tight adequately blood-supplied mucosal anastomosis is required for better outcomes. This review aimed to compare the outcome of vasovasostomy performed by three different techniques: macroscopic, pure microsurgical, and robot-assisted microsurgical techniques.
Scopus, Web of Science, PubMed, Embase, and Cochrane library databases were searched for relevant studies from January 1901 to June 2023. We conducted our quantitative syntheses using the inverse variance method in OpenMeta software. The study's protocol was registered on PROSPERO.
This review involved 95 studies of different designs, with a total sample size of 48,132. The majority of operations were performed bilaterally, and participants were monitored for up to 10 years. The pooled patency rate was the highest following robot-assisted vasovasostomy (94.4%), followed by pure microsurgical vasovasostomy (87.5%), and macroscopic vasovasostomy (83.7%). The pooled pregnancy rate following purely microsurgical vasovasostomy was higher than that of macroscopic vasovasostomy (47.4 vs. 43.7%). Definitive pregnancy rates in robotic vasovasostomy are yet to be determined.
Patency outcomes for vasovasostomy were best with robot-assisted microsurgical technique, followed by pure microsurgical technique, and conventional macroscopic technique. Further investigations of robot-assisted microsurgical vasovasostomy outcomes and randomized control trials are required to support this evidence.
输精管吻合术是一种用于输精管结扎逆转的经济有效的手术。为了获得更好的效果，需要进行水密且血供充足的黏膜吻合。本综述旨在比较三种不同技术（宏观技术、单纯显微外科技术和机器人辅助显微外科技术）进行输精管吻合术的结果。
检索了Scopus、科学网、PubMed、Embase和Cochrane图书馆数据库，以查找1901年1月至2023年6月的相关研究。我们在OpenMeta软件中使用逆方差法进行定量综合分析。该研究方案已在PROSPERO上注册。
本综述纳入了95项不同设计的研究，总样本量为48132。大多数手术为双侧进行，对参与者进行了长达10年的监测。机器人辅助输精管吻合术后的汇总通畅率最高（94.4%），其次是单纯显微外科输精管吻合术（87.5%）和宏观输精管吻合术（83.7%）。单纯显微外科输精管吻合术后的汇总妊娠率高于宏观输精管吻合术（47.4%对43.7%）。机器人输精管吻合术的确切妊娠率尚未确定。
输精管吻合术的通畅结果以机器人辅助显微外科技术最佳，其次是单纯显微外科技术和传统宏观技术。需要对机器人辅助显微外科输精管吻合术的结果进行进一步研究和随机对照试验来支持这一证据。
