Microsurgery for Fertility Specialists

Microsurgery for Fertility Specialists

Jay I. Sandlow Editor Microsurgery for Fertility Specialists A Practical Text

Editor Jay I. Sandlow, MD Department of Urology Medical College of Wisconsin Milwaukee, WI, USA ISBN 978-1-4614-4195-3 ISBN 978-1-4614-4196-0 (ebook) DOI 10.1007/978-1-4614-4196-0 Springer New York Heidelberg Dordrecht London Library of Congress Control Number: 2012942083 Springer Science+Business Media New York 2013 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, speci fi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on micro fi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied speci fi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com)

To my wife, Bridget, and my daughters, Samantha, Jacquelyn, and Rachel: your patience and understanding always remind me of what is important in life.

Preface Microsurgery for Fertility Specialists: A Practical Text is designed as a resource for physicians who specialize in the surgical treatment of infertility. This book will outline some of the basics of microsurgery, the indications, as well as various surgical techniques. It is intended for all providers who practice microsurgery in the fi eld of andrology. The fi eld has evolved over the years, from the use of loupe magni fi cation to state-of-the art operating microscopes. Although improvements in assisted reproductive technology (ART), speci fi cally intracytoplasmic sperm injection, has rendered some microsurgical procedures to become secondary to ART, many fertility specialists continue to provide excellent outcomes, as well as the restoration of fertility and sexual function, to their patients. This book is designed to provide these specialists with detailed operative descriptions of these surgical procedures, from vasectomy reversals to sperm acquisitions, tubal re-anastomosis, and even penile surgery. Furthermore, it is intended to help teach the next generation of microsurgeons, as I believe that it is incumbent upon us, as physicians, to pass on our knowledge. Each chapter is cowritten by both a junior and a senior author in order to allow more junior-level experts to gain valuable experience and knowledge. There are chapters that are speci fi cally dedicated to the education of residents and fellows, as they are the future of fertility surgery. Finally, the role of microsurgery in noninfertility procedures is covered as well. Microsurgery for Fertility Specialists will allow providers with a basic knowledge of infertility surgery to become better prepared in the fi eld, while those with more advanced knowledge will be able to utilize this resource to maintain and advance their microsurgical practice, as well as assist in the education of others. Milwaukee, WI, USA Jay I. Sandlow vii

Acknowledgments I would like to gratefully acknowledge the many people who have helped me prepare this book, as well as those who have helped my career along the way. This book would not have been possible without the outstanding contributions of each of the authors. Springer s Developmental Editor, Maureen Alexander has been invaluable in helping with the organization of this book. Finally, my administrative assistant, Cindy Ziebell, has worked tirelessly to collect, format, and prepare the various chapters. I would also like to thank all those who have in fl uenced my career and teaching philosophy. I inherited a strong desire to teach from my father, Dr. Les Sandlow, who had a long and distinguished career in academic medicine. My former chair, Dr. Richard Williams, nurtured my academic career and gave me the tools necessary to succeed. I have had many mentors, both formal and informal, who have taught me the clinical and research aspects of male infertility, and to them I am grateful for their guidance and wisdom. ix

Contents 1 Male Infertility Microsurgical Training... 1 Philip S. Li, Ranjith Ramasamy, and Marc Goldstein 2 Microsurgery Training: What Should a Resident Know? Should All Microsurgeons be Fellowship Trained?... 27 Ethan Grober and Peter N. Kolettis 3 Microsurgical Subinguinal Varix Ligation: Techniques and Technical Pearls... 35 Joshua A. Bodie and Jay I. Sandlow 4 Vasovasostomy Techniques for Microsurgery Specialists... 49 Kalen Rimar, Landon Trost, and Robert E. Brannigan 5 Epididymovasostomy: Tips and Tricks of the Trade... 69 James F. Smith and Ajay K. Nangia 6 Sperm Retrieval Techniques in Obstructive Azoospermia: MESA, PESA, and TESA... 85 Anand Shridharani and Jay I. Sandlow 7 Microsurgical Testicular Sperm Extraction: Technical Considerations... 95 Peter N. Schlegel 8 Noninfertility Scrotal Microsurgery... 109 Akanksha Mehta and Marc Goldstein 9 Testis-Sparing Surgery for Testicular Masses... 121 Oleksandr Stakhovskyi and Michael A.S. Jewett 10 Robotic Microsurgery for Male Infertility... 137 Sijo J. Parekattil, Ahmet Gudeloglu, and Jamin V. Brahmbhatt xi

xii Contents 11 The Role of Microsurgical Reconstruction in the Era of ICSI... 153 Karen Baker and Edmund Sabanegh Jr 12 Tubal Microsurgery... 167 Jeffrey M. Goldberg and Tommaso Falcone 13 Microsurgical Penile Revascularization, Replantation, and Reconstruction... 179 Jeffrey Lee Rosenblum and Arthur L. Burnett Index... 223

Contributors Karen Baker, MD Center for Male Fertility, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA Joshua A. Bodie, MD Department of Urology, University of Minnesota Medical Center, Minneapolis, MN, USA Jamin V. Brahmbhatt, MD Department of Urology, University of Tennessee Health Science Center, Memphis, TN, USA Robert E. Brannigan, MD Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA Arthur L. Burnett, MD Department of Urology, The Johns Hopkins Hospital, Baltimore, MD, USA Tommaso Falcone, MD Ob/Gyn and Women s Health Institute, Cleveland Clinic, Cleveland, OH, USA Jeffrey M. Goldberg, MD Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA Marc Goldstein, MD Department of Urology, Center for Male Reproductive Medicine and Microsurgery, Weill Cornell Medical College, Cornell University, New York, NY, USA Ethan Grober, MD, MEd Division of Urology, Mount Sinai and Women s College Hospital, University of Toronto, Toronto, ON, Canada Ahmet Gudeloglu, MD Department of Urology, Winter Haven Hospital and University of Florida, Winter Haven, FL, USA Michael A.S. Jewett, MD, FRCSC FACS Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Hospital and the University Health Network, University of Toronto, Toronto, ON, Canada xiii

xiv Contributors Peter N. Kolettis, MD Department of Surgery/Urology, University of Alabama- Birmingham, Birmingham, AL, USA Philip S. Li, MD Department of Urology, Center for Male Reproductive Medicine and Microsurgery, Weill Cornell Medical College, Cornell University, New York, NY, USA Akanksha Mehta, MD Department of Urology, Weill Cornell Medical College, Cornell University, New York, NY, USA Ajay K. Nangia, MBBS Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA Sijo J. Parekattil, MD Department of Urology, Winter Haven Hospital and University of Florida, Winter Haven, FL, USA Ranjith Ramasamy, MD Department of Urology, Center for Male Reproductive Medicine and Microsurgery, Weill Cornell Medical College, Cornell University, New York, NY, USA Kalen Rimar, BA, BS Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA Jeffrey Lee Rosenblum, MD The Rosenblum Center for Urologic Care, Exton, PA, USA Edmund Sabanegh Jr, MD Center for Male Fertility, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA Jay I. Sandlow, MD Department of Urology, Medical College of Wisconsin, Milwaukee, WI, USA Peter N. Schlegel, MD Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA Anand Shridharani, MD Department of Urology, Medical College of Wisconsin, Milwaukee, WI, USA James F. Smith, MD, MS Department of Urology, Obstetrics, Gynecology, and Reproductive Sciences, UCSF, San Francisco, CA, USA Oleksandr Stakhovskyi, MD Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Hospital and the University Health Network, University of Toronto, Toronto, ON, Canada Landon Trost, MD Department of Urology, The Mayo Clinic, Rochester, MN, USA