20. 21. 22.
23.
24.
25. 26.
27.
28.
29.
30. 31.
32.
33.
34.
35. 36.
37.
38. 39.
40. 41. 42.
43.
44. 45.
of the Male Reproductive Tract, vol. 2. Netherlands: Springer; 1980: 38-46. Lizza EF, Marmar JL, Schmidt SS, et al. Transseptal crossed vasovasostomy. J Urol. 1985;134:1131-1132. Berger RE. Triangulation end-to-side vasoepididymostomy. J Urol. 1998;159:1951-1953. McCallum S, Li PS, Sheynkin Y, et al. Comparison of intussusception pull-through end-to-side and conventional end-to-side microsurgical vasoepididymostomy: prospective randomized controlled study in male wistar rats. J Urol. 2002;167:2284-2288. Chan PT, Brandell RA, Goldstein M. Prospective analysis of outcomes after microsurgical intussusception vasoepididymostomy. BJU Int. 2005;96:598-601. Silber SJ, Kelly J. Successful autotransplantation of an intraabdominal testis to the scrotum by microvascular technique. J Urol. 1976;115:452-454. Goldstein M. Use of fresh human placenta for microsurgical training. J Microsurg. 1979;1:70-71. Goldstein M, Phillips DM, Sundaram K, et al. Microsurgical transplantation of testes in isogenic rats: method and function. Biol Reprod. 1983;28:971-982. Tamai S, Nakamura Y, Motomiya Y. Microsurgical replantation of a completely amputated penis and scrotum: case report. Plast Reconstr Surg. 1977;60:287-291. Cohen BE, May JW Jr, Daly JS, Young HH. Successful clinical replantation of an amputated penis by microneurovascular repair. Case report. Plast Reconstr Surg. 1977;59:276-280. Novick AC. Management of intrarenal branch arterial lesions with extracorporeal microvascular reconstruction and autotransplantation. J Urol. 1981;126:150-154. Sharlip ID. Penile revascularization in the treatment of impotence. West J Med. 1981;134:206-211. Marmar JL, DeBenedictis TJ, Praiss D. The management of varicoceles by microdissection of the spermatic cord at the external inguinal ring. Fertil Steril. 1985;43:583-588. Lemack GE, Uzzo RG, Schlegel PN, Goldstein M. Microsurgical repair of the adolescent varicocele. J Urol. 1998;160: 179-181. Tanrikut C, Goldstein M, Rosoff JS, et al. Varicocele as a risk factor for androgen deficiency and effect of repair. BJU Int. 2011;108: 1480-1484. Su LM, Goldstein M, Schlegel PN. The effect of varicocelectomy on serum testosterone levels in infertile men with varicoceles. J Urol. 1995;154:1752-1755. Jow WW, Steckel J, Schlegel PN, et al. Motile sperm in human testis biopsy specimens. J Androl. 1993;14:194-198. Tsujimura A, Matsumiya K, Miyagawa Y, et al. Conventional multiple or microdissection testicular sperm extraction: a comparative study. Hum Reprod. 2002;17:2924-2929. Schoysman R, Vanderzwalmen P, Nijs M, et al. Successful fertilization by testicular spermatozoa in an in-vitro fertilization programme. Hum Reprod. 1993;8:1339-1340. Schlegel PN, Li PS. Microdissection TESE: sperm retrieval in nonobstructive azoospermia. Hum Reprod Update. 1998;4:439. Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod. 1999;14: 131-135. History - Microsurgery, S & T Microsurgical. Telephone Interview with Arnold Belker. Horenz PG. 1986. Microscope With Correlatable Fixation Target. U.S. Patent number US 4614411 A filed May 16, 1985, and issued September 30, 1986. Belker AM, Thomas AJ Jr, Fuchs EF, et al. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol. 1991;145:505-511. Interview with Larry Lipshultz, 2014, May 13. Kuang W, Shin PR, Matin S, Thomas AJ Jr. Initial evaluation of robotic technology for microsurgical vasovasostomy. J Urol. 2004; 171:300-303.
974
46. Parekattil SJ, Atalah HN, Cohen MS. Video technique for human robot-assisted microsurgical vasovasostomy. J Endourol. 2010;24: 511-514. 47. Parekattil SJ, Cohen MS. Robotic surgery in male infertility and chronic orchialgia. Curr Opin Urol. 2010;20:75-79.
EDITORIAL COMMENT The authors1 provided an outstanding overview of the history of microsurgery in urology. Most of the discussion revolves around the application of microsurgery to treatment of male reproductive dysfunction, not other areas of urology. The use of magnification and enhanced imaging is certainly expanding to other areas of urology. For example, if one considers microsurgery to include use of loupe magnification for microsurgical reconstruction,2 then robotic and laparoscopic surgery could well be considered advances of optically magnified surgery in urology. The major advances with every microsurgical procedure are well documented with clear examples of the major contributors and important steps in development of the operations. The reader has the opportunity to better understand how these advances have occurred, which is helpful for those in training as well as in practice—and perhaps consider how additional innovations in surgical technique occur. It is interesting that the studies quoted are almost all observational studies, with few controlled studies for most of the new microsurgical techniques. In most cases, the improvements in microsurgery have been incremental rather than quantum leaps forward or major technologic advances because the technology is use of an operating microscope and microsurgical technique. Finally, it is important to consider that future innovations will need to be evaluated with cost considerations, as well as simple evaluation of the outcomes achieved with each surgical technique. The authors1 are to be commended for their thoughtful overview of the history of microsurgery in urology. Peter N. Schlegel, M.D., Department of Urology, Weill Cornell Medical College, New York, NY
References 1. Pastuszak AW, Wenker EP, Lipshultz LI. The history of microsurgery in urology. Urology. 2015;85:971-975. 2. Silber SJ, Crudop J. Kidney transplantation in inbred rats. Am J Surg. 1973;125:551-553.
http://dx.doi.org/10.1016/j.urology.2014.12.060 UROLOGY 85: 974, 2015. Ó 2015 Elsevier Inc.
REPLY The inspiration for compiling the history of microsurgery in urology arose from the authors’ fascination with microsurgical technique and applications and a desire to understand how current approaches to microsurgical applications resulted from a gradual, progressive, innovation process. It is tempting to speculate about future technologies and how they may further revolutionize contemporary microsurgery. Magnified laparoscopic and robotic surgery can certainly be considered advances in “microsurgery,” particularly when facilitating access to structures previously requiring a large incision followed by a precise approach requiring magnification. The future of microsurgery will likely incorporate novel
UROLOGY 85 (5), 2015
23.
24.
25. 26.
27.
28.
29.
30. 31.
32.
33.
34.
35. 36.
37.
38. 39.
40. 41. 42.
43.
44. 45.
of the Male Reproductive Tract, vol. 2. Netherlands: Springer; 1980: 38-46. Lizza EF, Marmar JL, Schmidt SS, et al. Transseptal crossed vasovasostomy. J Urol. 1985;134:1131-1132. Berger RE. Triangulation end-to-side vasoepididymostomy. J Urol. 1998;159:1951-1953. McCallum S, Li PS, Sheynkin Y, et al. Comparison of intussusception pull-through end-to-side and conventional end-to-side microsurgical vasoepididymostomy: prospective randomized controlled study in male wistar rats. J Urol. 2002;167:2284-2288. Chan PT, Brandell RA, Goldstein M. Prospective analysis of outcomes after microsurgical intussusception vasoepididymostomy. BJU Int. 2005;96:598-601. Silber SJ, Kelly J. Successful autotransplantation of an intraabdominal testis to the scrotum by microvascular technique. J Urol. 1976;115:452-454. Goldstein M. Use of fresh human placenta for microsurgical training. J Microsurg. 1979;1:70-71. Goldstein M, Phillips DM, Sundaram K, et al. Microsurgical transplantation of testes in isogenic rats: method and function. Biol Reprod. 1983;28:971-982. Tamai S, Nakamura Y, Motomiya Y. Microsurgical replantation of a completely amputated penis and scrotum: case report. Plast Reconstr Surg. 1977;60:287-291. Cohen BE, May JW Jr, Daly JS, Young HH. Successful clinical replantation of an amputated penis by microneurovascular repair. Case report. Plast Reconstr Surg. 1977;59:276-280. Novick AC. Management of intrarenal branch arterial lesions with extracorporeal microvascular reconstruction and autotransplantation. J Urol. 1981;126:150-154. Sharlip ID. Penile revascularization in the treatment of impotence. West J Med. 1981;134:206-211. Marmar JL, DeBenedictis TJ, Praiss D. The management of varicoceles by microdissection of the spermatic cord at the external inguinal ring. Fertil Steril. 1985;43:583-588. Lemack GE, Uzzo RG, Schlegel PN, Goldstein M. Microsurgical repair of the adolescent varicocele. J Urol. 1998;160: 179-181. Tanrikut C, Goldstein M, Rosoff JS, et al. Varicocele as a risk factor for androgen deficiency and effect of repair. BJU Int. 2011;108: 1480-1484. Su LM, Goldstein M, Schlegel PN. The effect of varicocelectomy on serum testosterone levels in infertile men with varicoceles. J Urol. 1995;154:1752-1755. Jow WW, Steckel J, Schlegel PN, et al. Motile sperm in human testis biopsy specimens. J Androl. 1993;14:194-198. Tsujimura A, Matsumiya K, Miyagawa Y, et al. Conventional multiple or microdissection testicular sperm extraction: a comparative study. Hum Reprod. 2002;17:2924-2929. Schoysman R, Vanderzwalmen P, Nijs M, et al. Successful fertilization by testicular spermatozoa in an in-vitro fertilization programme. Hum Reprod. 1993;8:1339-1340. Schlegel PN, Li PS. Microdissection TESE: sperm retrieval in nonobstructive azoospermia. Hum Reprod Update. 1998;4:439. Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod. 1999;14: 131-135. History - Microsurgery, S & T Microsurgical. Telephone Interview with Arnold Belker. Horenz PG. 1986. Microscope With Correlatable Fixation Target. U.S. Patent number US 4614411 A filed May 16, 1985, and issued September 30, 1986. Belker AM, Thomas AJ Jr, Fuchs EF, et al. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol. 1991;145:505-511. Interview with Larry Lipshultz, 2014, May 13. Kuang W, Shin PR, Matin S, Thomas AJ Jr. Initial evaluation of robotic technology for microsurgical vasovasostomy. J Urol. 2004; 171:300-303.
974
46. Parekattil SJ, Atalah HN, Cohen MS. Video technique for human robot-assisted microsurgical vasovasostomy. J Endourol. 2010;24: 511-514. 47. Parekattil SJ, Cohen MS. Robotic surgery in male infertility and chronic orchialgia. Curr Opin Urol. 2010;20:75-79.
EDITORIAL COMMENT The authors1 provided an outstanding overview of the history of microsurgery in urology. Most of the discussion revolves around the application of microsurgery to treatment of male reproductive dysfunction, not other areas of urology. The use of magnification and enhanced imaging is certainly expanding to other areas of urology. For example, if one considers microsurgery to include use of loupe magnification for microsurgical reconstruction,2 then robotic and laparoscopic surgery could well be considered advances of optically magnified surgery in urology. The major advances with every microsurgical procedure are well documented with clear examples of the major contributors and important steps in development of the operations. The reader has the opportunity to better understand how these advances have occurred, which is helpful for those in training as well as in practice—and perhaps consider how additional innovations in surgical technique occur. It is interesting that the studies quoted are almost all observational studies, with few controlled studies for most of the new microsurgical techniques. In most cases, the improvements in microsurgery have been incremental rather than quantum leaps forward or major technologic advances because the technology is use of an operating microscope and microsurgical technique. Finally, it is important to consider that future innovations will need to be evaluated with cost considerations, as well as simple evaluation of the outcomes achieved with each surgical technique. The authors1 are to be commended for their thoughtful overview of the history of microsurgery in urology. Peter N. Schlegel, M.D., Department of Urology, Weill Cornell Medical College, New York, NY
References 1. Pastuszak AW, Wenker EP, Lipshultz LI. The history of microsurgery in urology. Urology. 2015;85:971-975. 2. Silber SJ, Crudop J. Kidney transplantation in inbred rats. Am J Surg. 1973;125:551-553.
http://dx.doi.org/10.1016/j.urology.2014.12.060 UROLOGY 85: 974, 2015. Ó 2015 Elsevier Inc.
REPLY The inspiration for compiling the history of microsurgery in urology arose from the authors’ fascination with microsurgical technique and applications and a desire to understand how current approaches to microsurgical applications resulted from a gradual, progressive, innovation process. It is tempting to speculate about future technologies and how they may further revolutionize contemporary microsurgery. Magnified laparoscopic and robotic surgery can certainly be considered advances in “microsurgery,” particularly when facilitating access to structures previously requiring a large incision followed by a precise approach requiring magnification. The future of microsurgery will likely incorporate novel
UROLOGY 85 (5), 2015
