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By Philip S. Li M.D., Ranjith Ramasamy M.D. (auth.), Jay I. Sandlow (eds.)
Microsurgery for Fertility Specialists is a useful source for physicians who specialise in the surgical operation of female and male infertility. This sensible textual content explains the fundamentals of microsurgery and gives targeted operative descriptions of surgeries corresponding to vasectomy reversal, sperm retrieval, tubal reanastomosis, and penile surgical procedure. a superb cadre of reproductive experts stocks beneficial wisdom of the present nation of microsurgery, its position in infertility systems, and the most recent advances within the box --including a few non-infertility microsurgical options. The booklet is a vital academic advisor for people with a extra complex wisdom of microsurgical perform because it contains chapters that might support them mentor citizens and fellows, and encourage destiny generations of reproductive surgeons.
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Extra info for Microsurgery for Fertility Specialists: A Practical Text
Sample text
Other surgeons may prefer an empty scalpel handle or Penrose to similarly keep the cord elevated. In cases of bilateral varicocelectomy, a Penrose drain tagged around the cord works well to maintain control of the cord while the contralateral incision is performed, prior to bringing in the operative microscope. Under microscopic view, the external spermatic fascia, cremasteric muscle fibers, and internal spermatic fascia are then opened along the direction of the cord with electrocautery (Fig. 5).
When the sutures are tied down (a1–a2 and b1–b2), the epididymal tubule gently intussuscepts into the lumen of the vas (Fig. 21c). 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 (Fig. 21d). 2. Longitudinal double-armed two-suture intussusception end-to-side vasoepididymostomy (Fig. 22) [13]. 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.
We prefer to isolate the vas and vasal vessels first (Fig. 8), as to avoid inadvertent later injury to these vital structures. Microdissection is then performed to isolate the internal spermatic arteries, during which obvious veins are double ligated with 4-0 silk ties or vascular titanium clips (Horizon™) and sharply divided using Westcott scissors. Liberal utilization of the Doppler probe is advised to verify that any vessel or tissue about to be ligated is not arterial, and also to periodically identify the patency of the arterial supply elsewhere in the cord.