Figure 2.

Microdot vasovasostomy. (a) Discrepant lumens sizes between the abdominal and testicular ends are shown. (b) Microdots are made approximately one-third of the way between the lumen and the adventitial layer. (c) Double-arm 10-0 nylon sutures are passed precisely through three microdots. (d) 9-0 nylon sutures are placed exactly between the 10-0 mucosal sutures. (e) A third layer of 9-0 nylon sutures are placed between the 9-0 sutures in the second layer and directly overlying the 10-0 mucosal layer. (f) The anastomosis is flipped and an identical procedure is performed on the other side starting with three double-armed 10-0 nylon sutures. (g) Diagram showing the final fourth layer reapproximating the vasal sheath for less tension on the anastomosis.