@inproceedings{01K7GYS2JY4NF0T7AMDDVA4W55,
  abstract     = {{Introduction & Objectives: Obstructive azoospermia caused by vas deferens injury during abdominal 
surgery is a rare but impactful complication affecting male fertility. Traditional open microsurgical repair, 
while effective, poses significant technical challenges. Robotic-assisted microsurgery offers enhanced 
visualization, precision and maneuverability, representing a promising alternative. We present a case of 
robotic-assisted intra-abdominal vaso-vasostomy in a 43-year-old male with iatrogenic obstruction 
following laparoscopic inguinal mesh resection.
Materials & Methods: A 43-year-old man was referred with chronic left-sided scrotal and pelvic pain 
unresponsive to pharmacologic therapy, alongside newly diagnosed azoospermia and a future progeny 
desire. His medical history included bilateral inguinal hernia repair with mesh, followed by left mesh 
resection due to persistent pain and a right-sided orchidectomy for ischemic orchitis after right inguinal 
mesh resection. Preoperative scrotal ultrasound showed no abnormalities. Electromyography indicated 
intact ilioinguinal and iliohypogastric nerve function. Pelvic MRI revealed fibrotic tissue near the left 
spermatic cord but no structural abnormalities. Diagnostic spermatic cord block failed to relieve pain. 
Antegrade left deferentography under general anesthesia confirmed obstruction at the inguinal level, 
consistent with iatrogenic obstructive azoospermia.
Results: Patient underwent robotic-assisted vaso-vasostomy using the da Vinci surgical system with a 
standard four-port setup. This was combined with primary refractory inguinal herna repair on the left 
side. Intraoperative findings revealed strong fibrotic tissue and spermatic cord obstruction at the level of 
previous mesh placement. A two-layer anastomosis was performed with inner layer (mucosa-tomucosa) approximation, followed by outer layer (muscularis and adventitia) with interrupted 8-0 Prolene 
sutures. Console time was 120 minutes. There were no intra- or postoperative complications. The 
patient was discharged on postoperative day one. Semen analysis was scheduled at 3- and 6-months 
post-surgery.
Conclusions: Robotic-assisted intra-abdominal microsurgical vaso-vasostomy is a safe, feasible 
approach for managing iatrogenic obstructive azoospermia. The technique offers precise dissection and 
anastomosis with reduced tissue trauma. Further studies with long-term outcomes are necessary.}},
  articleno    = {{VE31}},
  author       = {{Van den Ende, Mauro and Allaeys, Mathias and Van Huele, Andries and Everaert, Karel and Hervé, François and Bou Kheir, George}},
  booktitle    = {{EUROPEAN UROLOGY OPEN SCIENCE}},
  issn         = {{2666-1691}},
  language     = {{eng}},
  location     = {{London, UK}},
  number       = {{Supplement}},
  pages        = {{VE31:S361--VE31:S361}},
  title        = {{Robotic assisted intra-abdominal microsurgical vaso-vasostomy for iatrogenic obstructive azoospermia : a case presentation}},
  url          = {{https://www.eu-openscience.europeanurology.com/article/S2666-1683(25)00573-7/fulltext}},
  volume       = {{79}},
  year         = {{2025}},
}