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Role of Robotics in Male Infertility

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One of the exciting topics of this year’s Midyear convention was the role of robotics in male infertility by Prof Jens Rassweiler. The indication for using this technology includes OAT-syndrome with varicocele and obstructive azoospermia. The first indication is that was discussed was cases with OAT-syndrome with varicocele. OAT-syndrome with varicocele is treated using the following techniques: Laparascopic varicocelectomy, microsurgical approach and sclerotherapy. Of the three approaches, sclerotherapy did not have good results since 40% of it resulted in recurrences.In laparoscopic varicocelectomy,  preservation of the testicular artery is achieved by careful dissection. The preservation of the said artery results in better results in treating infertility. If there is persistence of the varicocele, microsurgical approach is done which boasts of a 97% success rateThe second indication is obstructive azoospermia. This can be due to ejaculatory duct obstruction, refertilization and other reasons like iatrogenic, congenital or infectious causes.Ejaculatory duct obstruction is diagnosed by TRUS. The management for this is through transurethral resection. For refertilization, the main management comes in the form of a vaso-vasostomy. For the other reason like iatrogenic, congenital or infectious cause, s vaso-vasostomy or epididymo-vasostomoy can be utilized.A study was also presented which was entitled Robot-assisted vasovasostomy and vasoepididymostomy: Current and review of the literature by Gozen et al. It showed that animal studies conducted using robot-assisted surgery on obstructive azoospermia resulted in a high-rate of patency. In clinical studies, it had the same pattern as the animal studies which showed high rates of patency.The lecture proceeded with Prof Rassweiler showing videos of microsurgery and robot-assisted surgery (DaVinci system) on an obstructive azoospermia case which demonstrated excellent magnification and accuracy of movement. In conclusion , Prof Rassweiler explained again the indications for robotics in andrology. Optimal ergonomy at the console is achieved using robotics since the surgeon will be just sitting on the console, easy 3D rendering , 3:1 scaling for excellent magnification and basically eliminated surgeon tremors. The assistant also has ample space to work near the patient. -Written by Jon Alexis Montemayor

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