case_images: PMC4736349_01
case_images: Vertical little branch of vas artery supplying to vas were ligated. (a) The vertical little branch of vas artery supplying to vas were ligated and main artery was preserved, the vas veins had already preserved and isolated under the penrose. (b) Pattern of vas artery preservation.
case_images: AJA-18-154-g001.jpg
case_images: PMC4736349_01_AJA-18-154-g001.jpg
case_images: F1
case_images: The procedure was performed under a Zeiss operating microscope (Carl Zeiss, Berlin, German) with 4-21 magnification with modification, and will be described in detail in the following steps: (1) the right testis was delivered through a 3 cm vertical scrotal incision, and the vas was exposed at the junction of the straight and convoluted portions; (2) the vas deferens was subsequently hemi-transected, by cannulating the abdominal end of the vas with a 24-gauge angiocatheter sheath, which patency was confirmed by injecting diluted methylene blue of distal part of vas; (3) the vasal vessels was then carefully isolated for 2-3 cm and preserved, 2 vertical little branches of vas artery supplying vas were ligated (Figure 1), and the vas was then completely transected and its proximal part to the epididymis ligated; (4) the epididymis was inspected under the microscope with 4-8 magnification, and a 5 mm buttonhole was made in the cauda epididymidis tunica and one dilated tubule was selected; (5) the vas deferens was drawn through an opening in the tunica vaginalis, the vas was then secured with 2 interrupted 9-0 microsutures on the edge of epididymal tunica opening in proximity to the anastomotic site; (6) according to intraoperative configuration between epididymal tubule and vas deference, the needles of two double-armed 10-0 microsutures are placed transversely on the selected epididymal tubule (Figure 2a), and the needles were left in epididymal tubule before the incision was made to avoid the collapse; (7) then a 15 ophthalmic knife was used to incise the tubule transversely between the two needles of the sutures (Figure 2b), the epididymal fluid was aspirated with a 24-gauge angiocatheter connected to a 5 ml syringe.
case_images: Two-suture transverse vasoepididymostomy. (a) Two double-armed sutures were placed in perpendicular fashion. (b) Incised the tubule transversely with ophthalmic knife. (c) Sutures were placed sequentially in inside-out fashion to achieve 4-point anastomosis. (d) Complete anastomosis.
case_images: AJA-18-154-g002.jpg
case_images: PMC4736349_01_AJA-18-154-g002.jpg
case_images: F2
case_images: The procedure was performed under a Zeiss operating microscope (Carl Zeiss, Berlin, German) with 4-21 magnification with modification, and will be described in detail in the following steps: (1) the right testis was delivered through a 3 cm vertical scrotal incision, and the vas was exposed at the junction of the straight and convoluted portions; (2) the vas deferens was subsequently hemi-transected, by cannulating the abdominal end of the vas with a 24-gauge angiocatheter sheath, which patency was confirmed by injecting diluted methylene blue of distal part of vas; (3) the vasal vessels was then carefully isolated for 2-3 cm and preserved, 2 vertical little branches of vas artery supplying vas were ligated (Figure 1), and the vas was then completely transected and its proximal part to the epididymis ligated; (4) the epididymis was inspected under the microscope with 4-8 magnification, and a 5 mm buttonhole was made in the cauda epididymidis tunica and one dilated tubule was selected; (5) the vas deferens was drawn through an opening in the tunica vaginalis, the vas was then secured with 2 interrupted 9-0 microsutures on the edge of epididymal tunica opening in proximity to the anastomotic site; (6) according to intraoperative configuration between epididymal tubule and vas deference, the needles of two double-armed 10-0 microsutures are placed transversely on the selected epididymal tubule (Figure 2a), and the needles were left in epididymal tubule before the incision was made to avoid the collapse; (7) then a 15 ophthalmic knife was used to incise the tubule transversely between the two needles of the sutures (Figure 2b), the epididymal fluid was aspirated with a 24-gauge angiocatheter connected to a 5 ml syringe. The fluid was examined under light microscopy by the surgeon intraoperatively and many motile sperm were founded; (8) then sutures were placed sequentially in inside-out fashion to achieve 4-point anastomosis (Figure 2c and 2d).