Robotic Microsurgery in Male Infertility and Urology

Taking Robotics to the Next Level

Ahmet Gudeloglu; Jamin V. Brahmbhatt; Sijo J. Parekattil

Disclosures

Transl Androl Urol. 2014;3(1):102-112. 

In This Article

Abstract and Introduction

Abstract

The initial reports of robotic assisted microsurgery began to appear in the early 1990s. Animal and early human studies were the initial publications. Larger series papers have recently been published from a few institutions. The field of robotic assisted microsurgery is still in evolution and so are adjunctive tools and instruments. It is clearly a different and unique skill set—is it microsurgery or is it robotic surgery, or both. It is clear from history that the art of surgery evolves over time to encompass new technology as long as the outcomes are better for the patient. Our current robotic platforms may not be ideal for microsurgery, however, the use of adjunctive tools and instrument refinement will further its future potential. This review article presents the current state of the art in various robotic assisted microsurgical procedures in male infertility and urology. Some novel applications of taking microsurgery to areas not classically accessible (intra-abdominal vasovasostomy) and adjunctive tools will also be presented.

Introduction

The contribution of male factor infertility is approximately 50% in infertile couples.[1] Although about one third of male factor infertility is idiopathic, a significant number of infertile male patients have surgically correctable disorders such as a varicocele or vasal obstruction, either congenital or iatrogenic.[2] Microsurgical reconstructive approaches are the standard of care in these anomalies of the male reproductive system.[3] Microsurgery also plays a role as a diagnostic and therapeutic modality for men with non-obstructive azoospermia (NOA).[4]

Human evolution and our ability to develop and utilize new tools is an ongoing process that has progressed over billions of years. This innate ability or desire in our minds to progress is being described as a new framework called evolutionary psychology.[5] Evolutionary psychology supports the hypothesis that knowledge acquisition and the adaptive regulation of behavior is a dynamic and progressive process. Thus our development and use of new technology in surgical procedures is likely to progress in a similar fashion.

Similar to the acceptance of robotic assisted laparoscopic surgery for a number of urological conditions, the use of robotic assisted microsurgery is in its infancy and may progress as cheaper, cost effective robotic microsurgical platforms become more accessible.

This article covers the current state of the art in robotic assisted microsurgical procedures in male infertility and urology: microsurgical vasectomy reversal, intra-abdominal vasovasostomy (for patient with prior inguinal hernia related inguinal vasal obstruction), microsurgical subinguinal varicocelectomy, microsurgical testicular sperm extraction (MicroTESE) and targeted microsurgical denervation of the spermatic cord for chronic orchialgia.[6] Some novel adjunctive tools that assist in these procedures will also be presented.

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