Login to Access Video or Poster Abstract: MP89-18
Sources of Funding: None

Introduction

The purpose of our study is to assess the effect of fellow involvement in microsurgical cases with regard to operative time and postoperative outcomes

Methods

We performed a retrospective review of all patients undergoing microsurgical operations for infertility between July 2014 and September 2017. Utilizing patient electronic charts, operative times as well as resident and fellow surgical assistance were documented. Patient and female partner age, natural pregnancy rates, procedure type, pre- and post-operative semen parameters, time from vasectomy, and postoperative complications were all evaluated. The effects of a fellow surgical assistance on perioperative and postoperative outcomes were then analyzed. Statistical significance, defined as a p-value <0.05, was determined using Student's T, chi square or Fischer exact test.

Results

We identified 183 patients who underwent sub-inguinal varicocele ligation or vasectomy reversal by a single surgeon at our institution. All patients undergoing surgery for fertility concerns were included for analysis. Vasectomy reversals requiring one or more vaso-epididymostomy were excluded from analysis, due to insufficient numbers for meaningful comparison, as were any patients undergoing combined cases in addition to microsurgical surgery. Compared to when faculty was operating without a fellow (n=72), fellow surgical assistance (n=81) results in a statistically significant prolonged operative time for both unilateral varicocele ligation (1:22 vs 1:01, p<0.01), bilateral varicocele ligation (2:13 vs 1:43, p<0.01), and bilateral vaso-vasostomy (2:49 vs 2:19, p<0.01). Comparing fellow assisted cases to those without a fellow, there were no significant differences in all other outcome measurements or patient demographics. Overall, 69.0% of patients undergoing varicocelectomy experienced a significant improvement in their Total Motile Sperm Count post-operatively, and 100% of patients achieved patency after vasectomy reversal.

Conclusions

Fellowship training was associated with a ~30% increase in operative time for unilateral and bilateral varicocele ligation, and a ~20% increase in operative time for bilateral vaso-vasostomy, but does not adversely impact outcomes of microsurgical cases.

Funding

None