Microsurgical training is imperative for urologists and clinical andrologists specializing in male infertility. Success in male infertility microsurgery is heavily dependent on the surgeon＇s microsurgical skills. Lab...Microsurgical training is imperative for urologists and clinical andrologists specializing in male infertility. Success in male infertility microsurgery is heavily dependent on the surgeon＇s microsurgical skills. Laboratory-based practice to enhance microsurgical skills improves the surgeon＇s confidence, and reduces stress and operating time, benefiting both the patient and the surgeon. This review provides guidelines for setting up a microsurgical laboratory to develop and enhance microsurgical skills using synthetic and animal models. The role of emerginE techniaues, such as robotic-assisted microsureerv, is also discussed.展开更多
男性不育症是泌尿男科常见而复杂的疾病,长期以来缺少有效的外科治疗方法。随着男性不育显微外科和辅助生殖技术的出现,男性不育症的治疗得到飞速发展。美国康奈尔大学医学院(Weill Cornell Medical College of Cornell University)引...男性不育症是泌尿男科常见而复杂的疾病,长期以来缺少有效的外科治疗方法。随着男性不育显微外科和辅助生殖技术的出现,男性不育症的治疗得到飞速发展。美国康奈尔大学医学院(Weill Cornell Medical College of Cornell University)引领了男性不育显微外科发展的方向和进程。男性不育显微外科从系统地引入中国到今天被大家普遍接受,经历了漫长的过程。男性不育显微外科在中国近15年经历了引入、兴起和繁荣3个阶段,目前中国多家医院相继开展男科显微外科手术,初步建立了男性不育显微外科治疗体系。然而,在中国,男性不育显微外科医生仍然缺乏严格规范的显微外科技术培训,缺乏统一的男性不育评估标准和手术效果的评估,缺乏详细的患者术后随访数据。本综述回顾了男性不育显微外科在中国的发展历程,肯定了男性不育显微外科在中国的发展,也指出了不足,建议今后在显微外科医生的正规培训、建立标准化的男性不育显微手术前后评估和随访流程、在国内开展大规模男性不育显微手术协作临床科学研究等方面加强工作,促进男性不育显微外科在中国发展。展开更多
Microsurgical longitudinal intussusception vasoepididymostomy （LIVE） has been widely used to treat epididymal obstructive azoospermia since 2004. Although the deferential vasculature plays an important role in suppl...Microsurgical longitudinal intussusception vasoepididymostomy （LIVE） has been widely used to treat epididymal obstructive azoospermia since 2004. Although the deferential vasculature plays an important role in supplying blood to the testis and epididymis, little attention has been paid to the potential benefits of sparing the deferential vessels during the anastomosis in LIVE. This study aimed to evaluate the efficacy and safety of deferential vessel-sparing LIVE in humans. From December 2013 to December 2015, 69 azoospermic men with epididymal obstruction due to a genital infection, trauma, or idiopathic factors underwent deferential vessel-sparing LIVE in the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. The outcomes of these patients were analyzed retrospectively. The mean age was 31.1 years for men and 28.3 years for their partners. Fifty-nine （85.5%, 59/69） men were followed up after surgery for approximately 16 months. Patency was noted and confirmed by semen analysis （〉10 000 sperm/ml） in 83.1% （49159） of men. The natural pregnancy rate was 40.7% （24/59） by the end of the study, with 87.5% （21124） of these natural pregnancies achieved within 12 months after surgery. No severe adverse events or complications were observed. In this study, we present a novel technique for sparing the deferential vessels during LIVE. The preliminary outcomes show this technique to be safe with favorable patency and pregnancy rates.展开更多
文摘Microsurgical training is imperative for urologists and clinical andrologists specializing in male infertility. Success in male infertility microsurgery is heavily dependent on the surgeon＇s microsurgical skills. Laboratory-based practice to enhance microsurgical skills improves the surgeon＇s confidence, and reduces stress and operating time, benefiting both the patient and the surgeon. This review provides guidelines for setting up a microsurgical laboratory to develop and enhance microsurgical skills using synthetic and animal models. The role of emerginE techniaues, such as robotic-assisted microsureerv, is also discussed.
文摘男性不育症是泌尿男科常见而复杂的疾病,长期以来缺少有效的外科治疗方法。随着男性不育显微外科和辅助生殖技术的出现,男性不育症的治疗得到飞速发展。美国康奈尔大学医学院(Weill Cornell Medical College of Cornell University)引领了男性不育显微外科发展的方向和进程。男性不育显微外科从系统地引入中国到今天被大家普遍接受,经历了漫长的过程。男性不育显微外科在中国近15年经历了引入、兴起和繁荣3个阶段,目前中国多家医院相继开展男科显微外科手术,初步建立了男性不育显微外科治疗体系。然而,在中国,男性不育显微外科医生仍然缺乏严格规范的显微外科技术培训,缺乏统一的男性不育评估标准和手术效果的评估,缺乏详细的患者术后随访数据。本综述回顾了男性不育显微外科在中国的发展历程,肯定了男性不育显微外科在中国的发展,也指出了不足,建议今后在显微外科医生的正规培训、建立标准化的男性不育显微手术前后评估和随访流程、在国内开展大规模男性不育显微手术协作临床科学研究等方面加强工作,促进男性不育显微外科在中国发展。
基金This work was supported by grants from the National Natural Science Foundation of China （No. 81172432, 81302223, 81671449, and 81471449）, the Guangdong Province Natural Science Foundation （No. 2015A030313141 and 2015A030313013）, the Scientific and Technical Project of Guangdong Province （No. 2016B030230001, 2013B051000021, 2016A040403113, 2016A020214004, and 2016A020218007）, and the Scientific and Technical Project of Guangzhou city （No. 2013J4500010 and 201604020189）.
文摘Microsurgical longitudinal intussusception vasoepididymostomy （LIVE） has been widely used to treat epididymal obstructive azoospermia since 2004. Although the deferential vasculature plays an important role in supplying blood to the testis and epididymis, little attention has been paid to the potential benefits of sparing the deferential vessels during the anastomosis in LIVE. This study aimed to evaluate the efficacy and safety of deferential vessel-sparing LIVE in humans. From December 2013 to December 2015, 69 azoospermic men with epididymal obstruction due to a genital infection, trauma, or idiopathic factors underwent deferential vessel-sparing LIVE in the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. The outcomes of these patients were analyzed retrospectively. The mean age was 31.1 years for men and 28.3 years for their partners. Fifty-nine （85.5%, 59/69） men were followed up after surgery for approximately 16 months. Patency was noted and confirmed by semen analysis （〉10 000 sperm/ml） in 83.1% （49159） of men. The natural pregnancy rate was 40.7% （24/59） by the end of the study, with 87.5% （21124） of these natural pregnancies achieved within 12 months after surgery. No severe adverse events or complications were observed. In this study, we present a novel technique for sparing the deferential vessels during LIVE. The preliminary outcomes show this technique to be safe with favorable patency and pregnancy rates.
