Robotic Microsurgery for Male Infertility and Chronic Orchialgia

  • Jamin V. BrahmbhattEmail author
  • Sijo J. Parekattil


Since the use of the operating microscope for microsurgery in 1975, there has been a steady increase in the use of such technology in the operative management of male infertility and chronic testicular or groin pain. Added to the reports relating to greater patency rates and fertility rates of vasovasostomy performed with the operating microscope, the concepts of magnification have been successfully applied to vasoepididymostomy and varicocele ligation. More recently, microscopic spermatic cord neurolysis has demonstrated applicability to the treatment of groin and testicular discomfort. These techniques require varying degrees of microsurgical skills and an array of supporting technology, neither of which may be part of many urologist’s personal or technical armamentarium. The melding of improved visualization with magnification to an ergonomic platform that can be operated remotely has a significant application to testicular and reproductive surgery. Robotic assistance during surgical procedures has been utilized in a wide array of surgical fields with the above mentioned benefits. This chapter covers the latest developments in the robotic microsurgical platform, robotic microsurgical tools, and current evaluations of various robotic microsurgical applications for male infertility and patients with chronic testicular or groin pain.


Robotic microsurgery Vasovasostomy Chronic orchialgia Male infertility Intraoperative vascular Doppler ultrasound Spermatic cord denervation Spermatic cord neurolysis Varicocele ligation 



We would like to thank Dr. Johannes Vieweg, Dr. Li-Ming Su, Dr. Philip Li, Dr. Hany Atalah, Katy Lyall, David Regan, Dr. Rachana Suchdev, Intuitive Surgical and Vascular Technology Inc. for their continued support in the pursuit and refinement of robotic microsurgical techniques and tools.


  1. 1.
    Silber SJ. Microsurgery in clinical urology. Urology. 1975;6:150–3.PubMedCrossRefGoogle Scholar
  2. 2.
    Marmar JL. Modified vasoepididymostomy with simultaneous double needle placement, tubulotomy and tubular invagination. J Urol. 2000;163:483–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Berger RE. Triangulation end-to-side vasoepididymostomy. J Urol. 1998;159:1951–3.PubMedCrossRefGoogle Scholar
  4. 4.
    Chan PT, Li PS, Goldstein M. Microsurgical vasoepididymostomy: a prospective randomized study of 3 intussusception techniques in rats. J Urol. 2003;169:1924–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Fogdestam I, Fall M. Microsurgical end-to-end and end-to-side epididymovasostomy to correct occlusive azoospermia. Scand J Plast Reconstr Surg. 1983;17:137–40.PubMedCrossRefGoogle Scholar
  6. 6.
    Marmar JL, Kim Y. Subinguinal microsurgical varicocelectomy: a technical critique and statistical analysis of semen and pregnancy data. J Urol. 1994;152:1127–32.PubMedGoogle Scholar
  7. 7.
    Owen ER. Microsurgical vasovasostomy: a reliable vasectomy reversal. Aust N Z J Surg. 1977;47:305–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod. 1999;14:131–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Schultheiss D, Denil J. History of the microscope and development of microsurgery: a revolution for reproductive tract surgery. Andrologia. 2002;34:234–41.PubMedCrossRefGoogle Scholar
  10. 10.
    Silber SJ. Microscopic vasoepididymostomy: specific microanastomosis to the epididymal tubule. Fertil Steril. 1978;30:565–71.PubMedGoogle Scholar
  11. 11.
    Thomas Jr AJ. Vasoepididymostomy. Urol Clin North Am. 1987;14:527–38.PubMedGoogle Scholar
  12. 12.
    Owen ER. Microsurgical vasovasostomy: a reliable vasectomy reversal. J Urol. 1977;47:305–9.Google Scholar
  13. 13.
    Levine LA. Microsurgical denervation of the spermatic cord. J Sex Med. 2008;5:526–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Oliveira RG, Camara C, Alves Jde M, et al. Microsurgical testicular denervation for the treatment of chronic testicular pain initial results. Clinics (Sao Paulo). 2009;64:393–6.Google Scholar
  15. 15.
    Bourla DH, Hubschman JP, Culjat M, et al. Feasibility study of intraocular robotic surgery with the da vinci surgical system. Retina. 2008;28:154–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Casale P. Robotic pediatric urology. Expert Rev Med Devices. 2008;5:59–64.PubMedCrossRefGoogle Scholar
  17. 17.
    Colombo Jr JR, Santos B, Hafron J, et al. Robotic assisted radical prostatectomy: surgical techniques and outcomes. Int Braz J Urol. 2007;33:803–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Guru KA, Wilding GE, Piacente P, et al. Robot-assisted radical cystectomy versus open radical cystectomy: assessment of postoperative pain. Can J Urol. 2007;14:3753–6.PubMedGoogle Scholar
  19. 19.
    Rodriguez E, Chitwood Jr WR. Minimally invasive, robotic cardiac surgery. Ann Thorac Surg. 2008;85:357–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Cocuzza M, Pagani R, Coelho R, et al. The systematic use of intraoperative vascular doppler ultrasound during microsurgical subinguinal varicocelectomy improves precise identification and preservation of testicular blood supply. Fertil Steril. 2010;93(7):2396–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Kuang W, Shin PR, Matin S, Thomas Jr AJ. Initial evaluation of robotic technology for microsurgical vasovasostomy. J Urol. 2004;171:300–3.PubMedCrossRefGoogle Scholar
  22. 22.
    Kuang W, Shin PR, Oder M, Thomas Jr AJ. Robotic-assisted vasovasostomy: a two-layer technique in an animal model. Urology. 2005;65:811–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Schiff J, Li PS, Goldstein M. Robotic microsurgical vasovasostomy and vasoepididymostomy: a prospective randomized study in a rat model. J Urol. 2004;171:1720–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Schiff J, Li PS, Goldstein M. Robotic microsurgical vasovasostomy and vasoepididymostomy in rats. Int J Med Robot. 2005;1:122–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Schoor RA, Ross L, Niederberger C. Robotic assisted microsurgical vasal reconstruction in a model system. World J Urol. 2003;21:48–9.PubMedGoogle Scholar
  26. 26.
    Fleming C. Robot-assisted vasovasostomy. Urol Clin North Am. 2004;31:769–72.PubMedCrossRefGoogle Scholar
  27. 27.
    Parekattil SJ, Moran ME. Robotic instrumentation: evolution and microsurgical applications. Indian J Urol. 2010;26:395–403.PubMedCrossRefGoogle Scholar
  28. 28.
    Parekattil S, Cohen M, Vieweg J. Human robotic assisted bilateral vasoepididymostomy and vasovasostomy procedures: Initial safety and efficacy trial. Proc SPIE. 2009;7161:71611L.CrossRefGoogle Scholar
  29. 29.
    Parekattil S, Atalah H, Cohen M. Video technique for human robotic assisted microsurgical vasovasostomy. J Endourol. 2010;24:511–4.PubMedCrossRefGoogle Scholar
  30. 30.
    Corcione F, Esposito C, Cuccurullo D, et al. Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience. Surg Endosc. 2005;19:117–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Chen XF, Zhou LX, Liu YD, et al. comparative analysis of three different surgical approaches to varicocelectomy. Zhonghua Nan Ke Xue. 2009;15:413–6.PubMedGoogle Scholar
  32. 32.
    Cayan S, Shavakhabov S, Kadioglu A. Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique. J Androl. 2009;30:33–40.PubMedCrossRefGoogle Scholar
  33. 33.
    Al-Said S, Al-Naimi A, Al-Ansari A, et al. Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches. J Urol. 2008;180:266–70.PubMedCrossRefGoogle Scholar
  34. 34.
    Al-Kandari AM, Shabaan H, Ibrahim HM, et al. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology. 2007;69:417–20.PubMedCrossRefGoogle Scholar
  35. 35.
    Shu T, Taghechian S, Wang R. Initial experience with robot-assisted varicocelectomy. Asian J Androl. 2008;10:146–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of UrologyUniversity of Tennessee Health Science CenterMemphisUSA
  2. 2.Division of UrologyWinter Haven Hospital, University of FloridaWinter HavenUSA

Personalised recommendations