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Combined robotic and subinguinal microsurgical vasovasostomy for vasal obstruction after inguinal hernia repair
  1. Moshe Wald1 and
  2. Ryan Steinberg2
  1. 1Urology, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, USA
  2. 2Department of Urology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Dr Moshe Wald; moshe-wald{at}


Obstruction of the vas deferens may occur after inguinal hernia repair with mesh and lead to infertility. In cases where natural conception is desired and after obtaining test results that suggest the presence of spermatogenesis, surgical reconstruction can be attempted but may be difficult. Several approaches have been reported, including the laparoscopic mobilisation of the pelvic vas deferens, as well as mobilisation and passage of the scrotal vas deferens intra-abdominally for robot-assisted vasovasostomy. We describe a novel approach that used the surgical robot and a no-touch technique to mobilise the pelvic vas deferens and deliver it to the subinguinal region for subinguinal microsurgical vasovasostomy. This approach appeared to be feasible and safe, allows for simultaneous bilateral repair if needed, and was associated with rapid postoperative convalescence.

  • Urology
  • Urological surgery

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  • Contributors MW conceived and drafted the work. RS provided critical revision of the work and had substantial contributions to the acquisition of data for the work. MW and RS provided final approval of the version to be published. MW and RS both agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.