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Pros ans cons regarding use of robot-assisted vasectomy reversal surgeryAccording to team conclusion, count after robot-assisted surgery seems to be comparable over a year for the two open procedures, but the robotic procedure appears to result in a quicker return of sperm count. The team leader, Sijo Parekattil, M.D., thinks that "for a couple that's trying to get pregnant, this is a big deal." Many types of surgery are now being aided by robots. Despite surgeons continue to explore new areas in which they can be used, robotic vasectomy reversal is not without controversy among specialists. There are urologists who believe that using an expensive robot to do something that is already done well simply with a microscope is, at least, a waste of resources. Because vasectomy reversal costs are not covered by medical plans, most patients pay out of pocket for it. The robot-assisted procedure can cost $3,000 more than the microscope method. The big question is if this extra money is covered by improved outcomes - either pregnancy success rate or the time spent in surgery. It is too soon to have an answer since this robot-assisted surgery is a new technique, with a short life. But it has shown a meaningful decrease in the amount of time it takes for a vasectomy to be reversed. Because many hospital fees are based on time, cutting operating time might offset some of the extra charges associated with the use of the robot. It is also too soon to tell whether vasectomy reversal pregnancy success rate has improved since the mid-2009 conclusion of the one-year study in which 20 men had the robotic procedure and seven had the microscopic one. However, two months after surgery, the average sperm count in the robotic surgery group was 54 million, while in the microscopic surgery group it was 11 million. Early conclusions suggest that the difference in sperm count between the two procedures decreases over time, however. Another potential advantage of the robot-assisted procedure is less discomfort for some surgeons who would otherwise stand or sit with their backs bent for extended periods over a microscope. Of course, the robotic procedure has its limitations. Some urologists see surgical results of the robot-assisted procedure equivalent to the microscopic method, but also think in some special cases it might not be as useful. For instance, during very complicated reversals that involve clearing a secondary blockage that develops close to the testicles, the surgeon has to hold the sperm tube during surgery. That is very difficult to do robotically because a keen sense of pressure is needed in order to avoid crushing the microscopic tubes involved. But, in response of this problem, Parekattil, the team leader, has developed techniques to stabilize such small tubules while using the robot. Despite the study's small sample size, the general physicians opinion confirms robot-assisted surgery is promising, but still requires more evaluation of vasectomy reversal surgery risks. A longer follow-up of patients is also needed to yield more widely applicable results and see what works and what doesn't. The study findings, now online and to appear in an upcoming print edition of the Journal of Endourology, represent the first head-to-head comparison of robot-assisted vasectomy reversal and the microscope procedure that is widely used. 
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