Name:
Robotic Surgery for Male Infertility and Chronic Scrotal Content Pain
Description:
Robotic Surgery for Male Infertility and Chronic Scrotal Content Pain
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/9a12c94d-82cc-4968-907d-920957050427/videoscrubberimages/Scrubber_1.jpg?sv=2019-02-02&sr=c&sig=39tR0ZnNfUpx4vrfIqIvUacxKBz2GvqXOGq6lMTdOrc%3D&st=2026-05-24T11%3A03%3A30Z&se=2026-05-24T15%3A08%3A30Z&sp=r
Duration:
T00H14M55S
Embed URL:
https://stream.cadmore.media/player/9a12c94d-82cc-4968-907d-920957050427
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/9a12c94d-82cc-4968-907d-920957050427/OE-AG-SP-Video.mov?sv=2019-02-02&sr=c&sig=oYRMfyjuh4qWDQDVb7qWFv68NprPH9CpcDuzO5XUJnY%3D&st=2026-05-24T11%3A03%3A30Z&se=2026-05-24T13%3A08%3A30Z&sp=r
Upload Date:
2023-12-06T00:00:00.0000000
Transcript:
Language: EN.
Segment:1 Introduction.
SPEAKER: This video illustrates robotic surgery procedures for male infertility as well as chronic scrotal content pane.
Segment:2 Robotic OR set-up.
SPEAKER: Here is the OR setup including the location of the robot. Once the patient is prepped and draped, the surgical nurse prepares all robotic trocars and robotic instruments in addition to the standard open surgical instruments.
Segment:3 Robotic assisted vasovasostomy.
SPEAKER: First demonstration will be robotic-assisted microsurgical vasovasostomy. The procedure starts with the midline scrotal incision, then the proximal and distal ends of the vas deferens are prepared for the anastomosis, similarly to the standard fashion.
Segment:4 Docking process of the robot.
SPEAKER: Then the robotic platform is brought in from the right side of the patient.
SPEAKER: In this video, all the procedures are performed by using the SI robotic platform. Here, the robot is docked, and the trocars are being attached to the robotic arms.
SPEAKER: We use black diamond micro forceps for the left and right robotic arms and Pott's scissors in the fourth arm.
Segment:5 Robotic assisted vasovasostomy from surgeon console.
SPEAKER: Here, we demonstrate the view from the surgeon console. On the top, we have the robotic camera with 4x magnification. On the bottom left, a higher magnification view from a separate fifth arm, wee tom camera is seen. On the bottom right, real time view of semen microscopic examination.
SPEAKER: Once the proximal and distal ends of the vas are isolated, we usually place two 9-0 nylon sutures for the posterior vasal muscularis anastomosis.
SPEAKER: This is followed by two to three posterior mucosal lumen in astomotic sutures using double-armed 10-0 nylon suture.
SPEAKER: Anterior mucosal lumen anastomosis is then performed.
SPEAKER: Finally, the vasovasostomy is completed by placement of five to six 9-0 nylon sutures between the anterior vasal muscularis.
Segment:6 Robotic assisted vasoepididymostomy from surgeon console.
SPEAKER: Now we demonstrate robotic microsurgical technique for vasoepididymostomy. A dilated epididymal tubule is dissected out, and then tow double-armed 10-0 nylon sutures are placed around the tubule in preparation for involution vasoepididymostomy.
SPEAKER: The tubule is cut, and the fluid is sampled for presence of sperm. Once sperm is confirmed, we proceed with the anastomosis. 9-0 nylon suture is placed from the posterior muscularis of the vas to the surrounding adventitia for stabilization. Then the needle ends of the initially placed double-armed 10-0 nylon sutures are brought inside out on the vas mucosal lumen to involute the open epididymal tubule into the lumen of the vas.
SPEAKER: Finally, we placed 9-0 nylon suture anteriorly for further stabilization of the vas to the surrounding adventitia.
SPEAKER:
Segment:7 Robotic assisted varicocelectomy preparation.
SPEAKER: Here, we demonstrate robotic-assisted varicocelectomy. A small subinguinal incision is made in order to isolate the spermatic cord .
SPEAKER: Once the spermatic cord is isolated, the robotic platform is docked in from patient's right side, as it is shown previously.
Segment:8 Robotic assisted varicocelectomy from surgeon console.
SPEAKER: The surgeon's point of view is as shown here. For this procedure, we used black diamond micro forceps for the left and right robotic arms and a curved monopolar scissors for the fourth arm. We first separate the cremasteric muscles.
SPEAKER: Arteries are identified using real-time audio micro-Doppler. Dissection of the dilated veins is then performed.
SPEAKER: The veins are ligated using 3-0 silk ties. We utilized black and white 3-0 silk sutures for convenience in identifying the proximal and distal ends of the vein.
SPEAKER: The same process is performed for all the veins encountered.
SPEAKER: Once all the veins are ligated, the arteries are re-assessed for blood flow and the cord is then released.
Segment:9 Robotic microdissection testicular sperm extraction preparation.
SPEAKER: This video shows testicular sperm extraction technique with the assistance of the robotic platform. Once the tunica albuginea is incised, needles are placed right next to the vascular structures under the real-time ultrasound Doppler examination. We prefer to obtain specimens from those areas in order to increase the chance of sperm retrieval.
Segment:10 Robotic microdissection testicular sperm extraction from surgeon console.
SPEAKER: Black diamond micro forceps are placed in the right arm. Micro bipolar forceps are used on the left arm, and the Pott's scissors are used for the fourth arm. The robotic assistance provides clear magnification and also allows surgeon to examine the specimens at the same time with the embryologist.
SPEAKER: The last part of the video demonstrates robotic-assisted targeted microsurgical denervation
Segment:11 Robotic assisted targeted denervation of the spermatic cord from surgeon console.
SPEAKER: of spermatic cord for chronic scrotal content pain. A 1 to 2 centimeters transverse incision is made in the subinguinal area, and spermatic cord is brought up to the surface. We used black diamond micro forceps and micro bipolar forceps for the right and left arms respectively. Curved monopolar scissors is used for the fourth arm.
SPEAKER: We also utilized an additional camera arm, as shown in the right image, to provide an additional 16 to 18 optical magnification view for the surgeon in the console. We first oblate or ligate the cremasteric muscle layer around the spermatic cord. Intraoperative Doppler is used to assess the location of all arteries-- all the vessels in lymphatics which are collectively preserved.
SPEAKER: The perivasal tissue is now carefully ligated with cautery, with care given to preserve the deferensial artery into the vas deferens.
SPEAKER: The posterior lipomatous component of the cord is ligated. Then hydrodissection of the vas deferens is performed to ligate small diameter nerve fibers on the vas without damaging vessels. Finally, the cord is wrapped with a bioinert matrix material and secured using 6-0 Prolene sutures to minimize neuroma formation.
SPEAKER:
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