Pros and cons of robotic microsurgery as an appropriate approach to male reproductive surgery for vasectomy reversal and varicocele repair

Fertile Battle
Pros and cons of robotic microsurgery as an appropriate approach to male reproductive surgery for vasectomy reversal and varicocele repair

Volume 110, Issue 5, Pages 816–823


Peter Chan, M.D., Sijo J. Parekattil, M.D., Marc Goldstein, M.D., Larry I. Lipshultz, M.D., Parviz Kavoussi, M.D., Andrew McCullough, M.D., Mark Sigman, M.D.


PRO: Are the outcomes comparable or better than manual microsurgery?
CON: Are the outcomes comparable or better than manual microsurgery?

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Go to the profile of Micah J Hill
over 4 years ago

Im voting for the con on this one.  Ive only did a few vasectomy reversals during my REI fellowship, but they were fast and effective open.  On the REI side, I do robotic surgery.  The advantage is generally in avoiding a laparotomy or navigating significant pelvic adhesions.  Im not convinced scrotal surgery provides a good platform for this technology.  Several of the pro arguments talk about deeper surgery, which is probably a different discussion in my mind.

Go to the profile of Mary Samplaski
over 4 years ago

I have not seen any compelling evidence that the addition of the robot adds anything to skilled microsurgery (other than cost). High-quality microsurgery offers excellent outcomes for these patients, and without the added costs of the robot (with no improvements to justify that cost). 

Go to the profile of Jim Dupree
over 4 years ago

First, I would like to commend the editors and authors for their thorough summary of the pros and cons of using the robotic platform for reproductive medicine procedures.  

Medicine is constantly evolving, with new medications, tests, and tools being added regularly to the marketplace.  There is an inevitable balance and tension between early adoption and rigorous evaluation, since the best evaluations often take many years.  

In today's US healthcare marketplace, there is also increasing attention on "value", often defined as quality divided by costs (multiplied by appropriateness).  And I think the key question for the robotic platform is: "does it provide increased value over current approaches."  

I applaud the early adopters for their work exploring the frontiers of the robotics platform and defining what's possible.  Now, I think we need to turn our attention to a rigorous evaluation of the value of the platform.  All 6 authors have highlighted the current knowledge base for cost and quality, but our current knowledge has many limitations, as described by the authors.  Before we further expand this platform, I think we owe it to our patients, our field, and our healthcare system to evaluate rigorously the value it provides.  

Go to the profile of Jason Franasiak
over 4 years ago

This is a similar debate which arose first with gynecologic oncology and then with general gynecology when it came to the use of the robot. Much of the initial data showed increased time and increased cost with little benefit. Subsequent data showed improvements in outcomes as providers gained more experience with the platform. Perhaps this is the case with scrotal surgery as well. However, I remain unconvinced given the magnification platforms available for this type of surgery. This area of medicine appears to be in its infancy and thus we may see improved outcomes with its use. However, it does not seem like we are there just yet. More data are needed to show cost effectiveness and improved outcomes with its use.