Robot Assisted Vaso-Vasostomy and Inguinal Varicocele Repair

Abstract

The initial mistake before starting a robot assisted microsurgery program was to expect a haptic feedback from the instruments. This didn’t take into account the adaptation capacity of the human brain. The visual perception of the tension of the suture is in fact “felt” as tactile and replaces any need for a haptic feedback in the hands or fingers. This visual tactile feedback is already mastered by conventional microsurgeons. Even robot assisted macroscopic surgeons are now able to describe the hardness of a tissue while operating on tumors. Our microsurgical reconstruction program started in 2003 after we discovered the lack of tremor and the precise vision brought by the robot. The procedures were initially directly adapted from classical microsurgery. We first used 7/0 sutures, then shifted progressively down to 11/0 (http://www.gfmer.ch/Presentations_En/Robot_vasectomy_reversal_DeBoccard_2009.htm). In our opinion, the best suture sizes are 9/0 or 10/0. Many surgeons use nylon sutures, but we prefer polyglycolic acid ones since it does not induce reactions and does not leave any foreign material. The choice of the needle is very important according to the structure of the tissue but is left to the appreciation of the surgeon.