of the Male Reproductive Tract

, vol. 2. Netherlands: Springer; 1980:

38-46

20.

Lizza EF, Marmar JL, Schmidt SS, et al. Transseptal crossed vaso-

vasostomy.

J Urol

. 1985;134:1131-1132

21.

Berger RE. Triangulation end-to-side vasoepididymostomy.

J Urol

1998;159:1951-1953

22.

McCallum S, Li PS, Sheynkin Y, et al. Comparison of intussuscep-

tion pull-through end-to-side and conventional end-to-side micro-

surgical vasoepididymostomy: prospective randomized controlled

study in male wistar rats.

JUro

. 2002;167:2284-2288

23.

Chan PT, Brandell RA, Goldstein M. Prospective analysis of out-

comes after microsurgical intussusception vasoepididymostomy.

BJU

Int

. 2005;96:598-601

24.

Silber SJ, Kelly J. Successful autotransplantation of an intra-

abdominal testis to the scrotum by microvascular technique.

J Urol

. 1976;115:452-454

25.

Goldstein M. Use of fresh human placenta for microsurgical

training.

J Microsurg

. 1979;1:70-71

26.

Goldstein M, Phillips DM, Sundaram K, et al. Microsurgical

transplantation of testes in isogenic rats: method and function.

Biol

Reprod

. 1983;28:971-982

27.

Tamai S, Nakamura Y, Motomiya Y. Microsurgical replantation of a

completely amputated penis and scrotum: case report.

Plast Reconstr

Surg

. 1977;60:287-291

28.

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

29.

Novick AC. Management of intrarenal branch arterial lesions with

extracorporeal

microvascular

reconstruction

and

auto-

transplantation.

J Urol

. 1981;126:150-154

30.

Sharlip ID. Penile revascularization in the treatment of impotence.

West J Med

. 1981;134:206-211

31.

Marmar JL, DeBenedictis TJ, Praiss D. The management of vari-

coceles by microdissection of the spermatic cord at the external

inguinal ring.

Fertil Steril

. 1985;43:583-588

32.

Lemack GE, Uzzo RG, Schlegel PN, Goldstein M. Microsur-

gical repair of the adolescent varicocele.

. 1998;160:

179-181

33.

Tanrikut C, Goldstein M, Rosoff JS, et al. Varicocele as a risk factor

for androgen de

ciency and effect of repair.

BJU Int

. 2011;108:

1480-1484

34.

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

35.

Jow WW, Steckel J, Schlegel PN, et al. Motile sperm in human

testis biopsy specimens.

J Androl

. 1993;14:194-198

36.

Tsujimura A, Matsumiya K, Miyagawa Y, et al. Conventional

multiple or microdissection testicular sperm extraction: a compar-

ative study.

Hum Reprod

. 2002;17:2924-2929

37.

Schoysman R, Vanderzwalmen P, Nijs M, et al. Successful fertil-

ization by testicular spermatozoa in an in-vitro fertilization pro-

gramme.

Hum Reprod

. 1993;8:1339-1340

38.

Schlegel PN, Li PS. Microdissection TESE: sperm retrieval in non-

obstructive azoospermia.

Hum Reprod Update

. 1998;4:439

39.

Schlegel PN. Testicular sperm extraction: microdissection improves

sperm yield with minimal tissue excision.

Hum Reprod

. 1999;14:

131-135

40. History - Microsurgery, S & T Microsurgical.

41. Telephone Interview with Arnold Belker.

42. Horenz PG. 1986. Microscope With Correlatable Fixation Target.

U.S. Patent number US 4614411 A

led May 16, 1985, and issued

September 30, 1986.

43.

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

44. Interview with Larry Lipshultz, 2014, May 13.

45.

Kuang W, Shin PR, Matin S, Thomas AJ Jr. Initial evaluation of

robotic technology for microsurgical vasovasostomy.

J Urol

. 2004;

171:300-303

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 authors

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 reproduc-

tive dysfunction, not other areas of urology. The use of

magni

cation and enhanced imaging is certainly expanding to

other areas of urology. For example, if one considers microsur-

gery to include use of loupe magni

cation for microsurgical

reconstruction,

then robotic and laparoscopic surgery could

well be considered advances of optically magni

ed 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 ad-

vances have occurred, which is helpful for those in training as

well as in practice

—

and perhaps consider how additional in-

novations 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 im-

provements in microsurgery have been incremental rather than

quantum leaps forward or major technologic advances because

the technology is use of an operating microscope and micro-

surgical 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 tech-

nique. The authors

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

Pastuszak AW, Wenker EP, Lipshultz LI. The history of microsurgery

in urology.

Urology

. 2015;85:971-975

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.

2015 Elsevier Inc.

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 microsur-

gery. Magni

ed 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 magni

ca-

tion. The future of microsurgery will likely incorporate novel

974

UROLOGY 85 (5), 2015