Microsurgery Training: What Should a Resident Know? Should All Microsurgeons be Fellowship Trained?

  • Ethan Grober
  • Peter N. Kolettis


Surgery for male infertility has evolved into a highly specialized endeavor within the specialty of Urology. Most procedures in this field, including vasectomy reversal, varicocele ligation, and sperm retrieval are performed with microsurgery. In some Urology residency programs, training in male infertility may not be viewed as a priority and many Urology departments do not have a faculty member dedicated to this field. As a result, there is a perception among male infertility specialists that many urologists’ training is deficient in this area. This chapter outlines the need and scope of microsurgical training in residency and reviews the impact of fellowship training on the practice of urologic microsurgery.


Microsurgery Training Fellowship Education Residency 


  1. 1.
    Middleton RG, Belker AM. Macrosurgery or microsurgery for vasovasostomy? Contemp Urol. 1995; 55–60.Google Scholar
  2. 2.
    Crain DS, Roberts JL, Ambling CL. Practice patterns in vasectomy reversal surgery: results of a questionnaire study among practicing urologists. J Urol. 2004;171:311–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Silber SJ. Epididymal extravasation following vasectomy as a cause for failure of vasectomy reversal. Fertil Steril. 1979;31:309–15.PubMedGoogle Scholar
  4. 4.
    Chawla A, O’Brien J, Lisi M, Zini A, Jarvi K. Should all urologists performing vasectomy reversals be able to perform vasoepididymostomies if required? J Urol. 2004;172:1048–50.PubMedCrossRefGoogle Scholar
  5. 5.
    Belker AM, Thomas Jr AJ, Fuchs EF, Konnak JW, Sharlip ID. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol. 1991;145:505–11.PubMedGoogle Scholar
  6. 6.
    Fuchs EF, Burt RA. Vasectomy reversal performed 15 years or more after vasectomy: correlation of pregnancy outcome with partner age and with pregnancy results of in vitro fertilization with intracytoplasmic sperm injection. Fertil Steril. 2002;77:516–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Nangia AK, Likosky DS, Wang D. Distribution of male infertility specialists in relation to the male population and assisted reproductive technology centers in the United States. Fertil Steril. 2010;94:599–609.PubMedCrossRefGoogle Scholar
  8. 8.
    Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod. 1999;14:131–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Grober ED, Elterman DS, Jewett MAS. Fellow or foe: the impact of fellowship training programs on the education of Canadian urology residents. Can Urol Assoc J. 2008;2:1–38.Google Scholar
  10. 10.
    Hemal AK, Menon M. Robotics in urology. Curr Opin Urol. 2004;14:89–93.PubMedCrossRefGoogle Scholar
  11. 11.
    Reznick RK. Virtual reality surgical simulators: feasible but valid? J Am Coll Surg. 1999;189:127–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Endourological Society. Recognized fellowship programs. Accessed 17 July 2012.
  13. 13.
    Society of Pediatric Urology. Participating fellowship programs. Accessed 17 July 2012.
  14. 14.
    Society of Urologic Oncology. Approved fellowship programs. Accessed 17 July 2012.
  15. 15.
    Fox M. Vasectomy reversal-microsurgery for best results. Br J Urol. 1994;73(4):449–53.PubMedCrossRefGoogle Scholar
  16. 16.
    Al-Said S, Al-Naimi A, Al-Ansari A, Younis N, Shamsodini A, A-Sadiq K, Shokeir AA. Varicocelectomy for male infertility: a comparative study of open, laparascopic and microsurgical approaches. J Urol. 2008;180(1):266–70.PubMedCrossRefGoogle Scholar
  17. 17.
    Al-Kandari AM, Shabaan H, Ibrahim HM, Elshebiny YH, Shokeir AA. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology. 2007;69(3):417–20.PubMedCrossRefGoogle Scholar
  18. 18.
    Klein EA, Bianco FJ, Serio AM, Eastham JA, Kattan MW, Pontes JE, Vickers AJ, Scardino PT. Surgeon experience is strongly associated with biochemical recurrence after radical prostatectomy for all preoperative risk categories. J Urol. 2008;179(6):2212–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Vickers AJ, Bianco FJ, Serio AM. The surgical learning curve for prostate cancer control after radical prostatectomy. J Natl Cancer Inst. 2007;99:1171–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Chawla A, O’brian J, Lisi M, Zini A, Jarvi K. Should all urologists performing vasectomy reversals be able to perform vasoepididymostomies if required? J Urol. 2004;172(3): 1048–50.PubMedCrossRefGoogle Scholar
  21. 21.
    Crain DS, Robert JL, Amling CL. Practice patterns in vasectomy reversal surgery: results of a questionnaire study among practicing urologists. J Urol. 2004;171(1):311–5.PubMedCrossRefGoogle Scholar
  22. 22.
    American Society for Reproductive Medicine. Fellowship opportunities. Accessed 17 July 2012.
  23. 23.
    Williams IV DH, Karpman E, Grober ED, Schrepferman CG, Crain DS, Chuang WW, Shin D, Khera M, Kuang W, Tanrikut C. Early vasectomy reversal experience and outcomes of fellowship-trained microsurgeons. J Urol. 2009;181:4–729.Google Scholar
  24. 24.
    Bianco FJ, Cronin AM, Klein EA, Pontes JE, Scardino PT, Vickers AJ. Fellowship training as a modifier of the surgical learning curve. Acad Med. 2010;85(5):863–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Oliak D, Owens M, Schmidt HJ. Impact of fellowship training on the learning curve for laparascopic gastric bypass. Obes Surg. 2004;14(2):197–200.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Division of Urology, Mount Sinai and Women’s College HospitalUniversity of TorontoTorontoCanada
  2. 2.Department of Surgery/UrologyUniversity of Alabama-BirminghamBirminghamUSA

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