Vasovasostomy: Multilayer Microsurgical Anastomosis

  • Sheldon H. F. Marks


The techniques for the modern microsurgical vasovasostomy have evolved with advances and refinements from the modified one-layer to the two-layer to the current multilayer reversal. Microdots allow for a more consistent and precise placement of the microsutures. The three most common techniques for vasal stabilization include the Goldstein Microspike clamp, the Microwipe technique, as well as the stay sutures over a wood tongue depressor.

Because of concerns over expenses, a cost-effective microsurgical VV has been developed and perfected with very high success. This technique and the standard multilayer vasovasostomy and the modified one-layer and the two-layer repair are described.


Evolution of surgical techniques Microdots Vas stabilization Goldstein Microspike clamp Microwipe stabilization technique Cost-effective multilayer VV Standard multilayer VV Modified one-layer VV Two-layer vasovasostomy 


  1. 1.
    Dickey RM, Pastuszak AW, Hakky TS, Chandrashekar A, Ramasamy R, Lipshultz LI. The evolution of vasectomy reversal. Curr Urol Rep. 2015 Jun;16(6):40.CrossRefGoogle Scholar
  2. 2.
    Kim HH, Goldstein M. History of vasectomy reversal. Urol Clin North Am. 2009 Aug;36(3):359–73.CrossRefGoogle Scholar
  3. 3.
    Baker K, Sabaneugh E Jr. Obstructive azoospermia: reconstructive techniques and results. Clinics. 2013;68(Suppl1):61–73.CrossRefGoogle Scholar
  4. 4.
    Pastuszak AW, Wenker EP, Lipshultz LI. The history of microsurgery in urology. Urology. 2015;85(5):971–4.CrossRefGoogle Scholar
  5. 5.
    Crain DS, Roberts JL, Amling CL. Practice patterns in vasectomy reversal surgery: results of a questionnaire study among practicing urologists. J Urol. 2004;171:311–5.CrossRefGoogle Scholar
  6. 6.
    Goldstein M, Li PS, Matthews GJ. Microsurgical vasovasostomy: the microdot technique of precision suture placement. J Urol. 1998;159:188–90.CrossRefGoogle Scholar
  7. 7.
    Walsh PC, editor. Campbell's urology. 8th ed. Philadelphia: WB Saunders; 2002. p. 1533–87.Google Scholar
  8. 8.
    Goldstein M. Microspike approximator for vasovasostomy. J Urol. 1985;134:74.CrossRefGoogle Scholar
  9. 9.
    Schwarzer JU. Vasectomy reversal using a microsurgical three-layer technique: one surgeon’s experience over 18 years with 1300 patients. Int J Androl. 2012;35:706–13.CrossRefGoogle Scholar
  10. 10.
    Fischer MA, Grantmyre JE. Comparison of modified one- and two-layer microsurgical vasovasostomy. BJU Int. 2000;85:1085–8.CrossRefGoogle Scholar
  11. 11.
    Nyame YA, Babbar P, Almassi N, Polackwich AS, Sabanegh E. Comparative cost-effectiveness analysis of modified 1-layer versus formal 2-layer vasovasostomy technique. J Urol. 2016;195:434–8.CrossRefGoogle Scholar
  12. 12.
    Ramasamy R, Schlegel PN. Vasectomy and vasectomy reversal: an update. Indian J Urol. 2011;27(1):92–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sheldon H. F. Marks
    • 1
  1. 1.University of Arizona College of MedicineInternational Center Vasectomy ReversalTucsonUSA

Personalised recommendations