Vasectomy Reversal Step-by-Step

Getting started.
Once you are comfortably sedated and asleep and the tissues are anesthetized, we bring out the segment of damaged vas (like a loop of spaghetti out of a button hole) through a very small incision in the front of the scrotum.

Prepping the vas.
Using the Marks Vas Cutting Forceps, the vas is cut in healthy tissue above and below the vasectomy scar, which is removed.

Analyzing the fluid.
A tiny drop of the fluid that comes out of the vas is analyzed under a lab microscope (we have our own full-time andrologist to do this). If we see sperm or sperm parts, this confirms that the system is open and there is no deeper blockage, so a vas-to-vas connection is performed.

The vas-to-vas connection.
A 3 to 4 multi-layer reversal is performed using our high-power Leica surgical microscope. The inner layer on both sides is sewn together with six or seven 10-0 nylon microsutures (each suture is a quarter thickness of an eyelash and about as long). The next layer is connected with individual 9-0 nylon sutures, each one millimeter apart, around the vas. Then the next layer or two of the outer tissues are than connected with multiple 7-0 nylon sutures to bring the blood supply to the repair site. This takes about 1 to 1.5 hours to do each side.

The other side, all over again.
Once more numbing medicine is instilled into the tissues around the vas, the newly connected vas is placed back into the left side and this process repeated the very same way on the right side.

What if there’s no sperm in the fluid?
If we see no sperm, this tells us that there’s deeper obstruction in the epididymis from a blowout from the buildup of pressure and a vas-to-epididymal bypass is needed (many doctors can’t or won’t do this even though it is the only way the connection will work – they just do a vas-to-vas connection knowing there is a 0% chance for success). The epididymis, where the blockage is located, is then examined under the surgical microscope.

A single microscopic epididymal tubule above the blockage and opened to confirm sperm are present. Then the tiniest micro 10-0 nylon sutures are placed alongside the open tubule, which is drawn up into the end of the abdominal vas and secured in multiple layers. This also takes about 1 to 1.5 hours to perform. Then all the layers are closed and you are walked to recovery, feeling great and pain free!

To answer any additional questions, set up a no-cost phone, Skype, Face Time or office consult or schedule your reversal, contact us at or call 888-722-2929.