The LIVE technique was developed at Cornell in 2003, which has become our preferred microsurgical technique for vasoepididymostomy. The setup is identical to that for the single-armed suture technique described above in which the abdominal side of the vas is anchored to the epididymal tunic with a single 10-0 nylon suture. However, two 10-0 nylon double-armed sutures are used (Sharpoint AK-0101, Surgical Specialties Corp.) with a different suture placement pattern. In the initial step, one needle from each of the two sutures is placed longitudinally along both edges of the selected epididymal tubule parallel to each other in the same configuration as above, without pulling the needles through, then, the epididymal tubule is opened longitudinally between the two needles. The needles are pulled through and prepared for placement through the vas . Starting with the first suture, the needle on one end is passed inside-out through the mucosal layer of the vas at position a1 while the needle on the other end is passed inside-out through position a2 . The same maneuver is performed with the second suture. One needle is passed inside-out through the mucosal layer of the vas at position b1 and the needle on the other end of the suture is passed inside-out through position b2). The two sutures are tied down (a1 to a2 and b1 to b2), resulting in intussusception of the epididymal tubule into the vasal lumen.
The epididymal tunic is secured to the vasal muscle and adventitia with eight to ten interrupted 10-0 nylon sutures using the remaining length of the single-armed sutures.
The advantages of the longitudinal end-to-side intussusception technique are:
- One or two sutures are easily placed in a distended tubule.
- Epididymal fluid can be examined before anastomosis
- Fewer micro-needles to manipulate
- The intussusception of the epididymal tubule into the vasal lumen provide a less likely to leak anastomosis. The flow of epididymal fluid is from the epididymis into the vas deferens, causing the epididymal tubule walls to plaster up against the inside of the vasal lumen.
- There is minimal bleeding associated with the technique.
- Clinical outcomes superior
The keys to successful employment of the triangulation end-to-side technique are:
- Extensive microsurgical training and expertise.
- A tension free accurate anastomosis
- A very meticulous and organized approach to suture placement.
Longitudinal Intussusception Vasoepididymostomy (LIVE) video at Youtube: