I'm excited to share a milestone from the microsurgery side of my practice: we've just published a peer-reviewed technical report describing a step-by-step single-armed longitudinal intussusception vasoepididymostomy (SA-LIVE) technique, using an ex vivo rat testis training model, paired with a video demonstration.
Even better, I had the honour of publishing this work as co-first author alongside Dr. Yelena Akelina, whose teaching has shaped how many of us approach microsurgical practice.
Why this paper matters
For patients exploring fertility after vasectomy, "vasectomy reversal" is often used as a catch-all term. In reality, the operation can involve different microsurgical reconnections depending on what we find at surgery.
One of the most technically demanding reconstructions is vasoepididymostomy (VE): a microsurgical connection between the vas deferens and the epididymal tubule when a blockage is present. VE is the sort of procedure where small, repeatable technical details matter. A lot.
The challenge is that high-quality practice opportunities are limited, and traditional intussusception VE techniques often rely on double-armed microsutures, which can be costly and harder to source consistently for repeated lab practice. That's where SA-LIVE comes in.
What we actually published
In this report, we outline a standardised, reproducible sequence for SA-LIVE using readily available single-armed 10-0 and 9-0 nylon sutures, with the aim of making skills training more accessible and reproducible. A key point: this is an education-focused technical report. It's designed as a training resource and does not present comparative outcome data.
To make the technique easier to learn and teach, we paired the written steps with a video demonstration aligned to the sequence. The practical value, especially for surgeons with foundational microsurgical skills who want a structured way to build VE comfort:
- Lower barriers to practice by reducing reliance on double-armed sutures.
- Clear sequencing (still images can miss the microsurgical "rhythm"; video helps).
- Repeatable lab training using an ex vivo model to support deliberate practice.
Video demonstration
The video below is the demonstration linked in the paper, recorded at the Microsurgery Training & Research Laboratory at NewYork-Presbyterian/Columbia University Irving Medical Center.
Behind the scenes
Working with Dr. Akelina was exactly what you'd hope for in a high-level training environment: precise expectations, thoughtful feedback, and a steady focus on reproducibility. The Microsurgery Lab trains more than 200 surgeons per year through its courses, and that context matters. A technique write-up is only as useful as its ability to be taught, repeated, and audited against a consistent standard. We also included original step-by-step illustrations created specifically for this write-up.
What this means for patients
If you're a patient reading this and wondering whether any of this affects your outcome, the honest answer is yes, indirectly. Training and repetition are part of what keeps complex microsurgery safe and consistent. This paper is one small piece of the bigger commitment to doing the fundamentals well, every time.
If you have been told that you may need a vasoepididymostomy, or if a previous reversal has not resulted in the return of sperm, I am happy to discuss your case. Your initial consultation is free.
This post is for general information only and is not personal medical advice. If you're considering vasectomy reversal or fertility options, the right approach depends on your history and a full clinical assessment.