T h e first vasovasostomy was performed by Quinby and O'Conor in 1915 and reported by O'Conor in 1948.' Although Fernandes and associates reported the use of microsurgery in experimental vasovasostomy in 1968, Silber and Owen are generally credited for describing the use of microsurgical techniques in performing two-layer anastomosis of the vas deferens in humans.2p5 The macroscopic vasovasostomy with and without loupe magnification was used extensively in the interval between 1948 and 1977. Although several authors maintain enthusiasm for the macroscopic technique, ' ' 12, 14-20 review of published results would suggest superior results are obtained with the use of the microscope when compared to macroscopic or loupe magnification vasovasostomy . l 3 While debate continues regarding the merits of macroscopic or loupe magnified vasovasostomy (decreased cost, reduced operative time, lower skill level requirement), the need for microscopic magnification in performing single tubule vasoepididymostomy is clear. For the dedicated infertility surgeon, the versatility necessary to perform either vasovasostomy or vasoepididymostomy justifies the use of the microscope in providing each patient optimum care.
Recent investigations focus upon simplification of vasovasostomy by incorporation of either laser welding or fibrin glue to assist in obtaining a secure and patent anastomosis. We will examine current techniques in microscopic vasovasostomy and innovations under evaluation.
CURRENT TECHNIQUE: MICROSURGICAL SUTURE ANASTOMOSIS Preoperative Counseling, Informed Consent
In preparation for vasovasostomy , patients are informed of the potential risks and benefits of the procedure. With respect to time since vasectomy (or presumed vasal injury in cases of traumatic disruption of the vas), we estimate the