Post Vasectomy Pain Forum

Reinforcing vasal suture reversal technique (ReVas)

I ran across this study from Feb 2020 on a new reversal technique introduced by Landon Trost (former male infertility specialist from the Mayo Clinic) and Joshua Savage (his physician assistant).

The idea is pretty simple – reduce scarring incidents by reducing strain on the reconnection site via extra sutures:

image

A is traditional, B is ReVas.

It’s early results (they introduced ReVas in 2018) but the results look promising in terms of higher and longer-lasting sperm count as well as much higher pregnancy rates. Not sure on how or if this would change the risk of new-onset pain following the reversal.

Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995932/

More info on the clinic’s website: https://malefertilityandpeyroniesclinic.com/vasectomy-reversal/revas

Interested in any thoughts on the study / approach.

cc @S_Parekattil_MD

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(Updated to add link to the study)

Not sure this technique can be used in all cases. I think if you had an aggressive “air gap” created/large vasal segment excised … that would leave less tissue to make a structure like that one. If you are close to the epi I don’t think you could do that.

The practice of aggressive resection removal of a vasal segment in conjunction with aggressive use of cautery and fascial interposition… those things could make this technique unrealistic.

I think all men that decide to go through with vasectomy would be best served to instruct the surgeon to use minmal cautery, no resection of vasal tissue, and no fascial interposition… If those things are done you might have enough viable vas to do something like this here consistently.

My testicles already sit a LOT higher after reversal… any higher and I would be self conscious about it or moreso.

This technique looks like you end up losing another inch of vas. I think simply supporting your testicles for the first few months after surgery would achieve this without all that crazy positioning of the vas.

I had the same or similar thoughts as @MikeO regarding the ReVas technique.

I have never seen this technique mentioned in a forum like this one before. In fact, it’s a new on on me, so thanks for sharing @alden.

This technique goes against the majority of thoughts I am aware of in regard to PVPS, PVPS reversals, etc.

More stitches, more trauma, more scarring - let alone a major loss of length of the vas deferens, a redo reversal doesn’t seem like a viable option anymore, etc.

I find it interesting that many studies suggest things that the majority of other studies, practical thoughts, etc, don’t align so well with.

Dear all,
Dr. Trost was one of my clinical fellows in 2013 and did his fellowship/training with us. He actually modified this technique from us. We have been using this technique to take the tension off the vas anastomosis since 2007. We actually just place one 3-0 Prolene suture in the adventitia around the vas to take the tension off the anastomosis so that the vas would not be accidentally pulled apart if the testicle is pulled down aggressively. We try not to place a lot of sutures in this area, and in the original technique - we only place one suture and not a bunch sutures as Dr.Trost has suggested.
Hope this helps

Sijo Parekattil, M.D.
sijo@avantconciergeurol.com
Cell 863-258-4999

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Thanks all! @S_Parekattil_MD didn’t realize that you and Dr. Trost had that connection. Yeah, it makes sense that the ReVas variation would trade extra re-enforcement against more stitches and more vas-length consumed – likely not a good fit for pain patients.

I’d be sceptical of this, from a PVPS perspective. The study linked higher up has sperm concentration and pregnancy rate as it’s only measured outcome. Pain / discomfort isn’t mentioned at all. For all we know, all these guys could have increased discomfort, partially du to more stitches and more scarring, and because of the loss of vas length so their testicles sit high in the groin.
As long as they can’t give any numbers on post-procedure pain, I’d stay clear.