Vasectomy reversal performed by vasovasostomy is done using an operating microscope that provides magnification 25 times the normal image size. This is important since the size of the vas deferens is about the same as a piece of spaghetti and should be sewn in two-layers to offer the highest pregnancy rates. Microscopic suture (10-0 nylon) unseen by the naked eye is used during the vasectomy reversal. It is important to use this fine suture to prevent leakage of sperm and to minimize obstruction of the lumen of the vas deferens by the suture itself. The cost of the suture itself is over $900 per vasectomy reversal!
The initial step during a vasectomy reversal is to identify whether or not there are sperm in the testicular end of the vas deferens. If sperm are identified, then a vasovasostomy can be performed successfully using microsurgical technique. If sperm are not identified then a secondary epididymal obstruction has developed and re-connecting the vas deferens at the site of vasectomy will universally be unsuccessful. This occurs 30% of the time and is dependent on several factors such as the time since your vasectomy and the site of your vasectomy. If sperm are not seen then an epididymovasostomy will be required in order to reverse the vasectomy. (see below)
The next step in a vasectomy reversal is to re-approximate the ends of the vas deferens in a tension-free manner. The 10-0 Nylon suture provides a water-tight closure for the sperm to travel through the vas deferens. If larger sized suture is used, it can cause obstruction in the vasal lumen itself.