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Mobilization of the distal vas. A tension-free anastomosis is essential. Gentle blunt dissection paired with judicious use of thermal cautery can be used to mobilize the distal vas to the external ring. When necessary, the scrotal incision can be extended cranially to aid in the dissection. In extreme cases, the inguinal canal can be opened, and the vas can be mobilized through the level of the internal ring. These maneuvers provide several centimeters of additional length.
