Training and Succession

Metrocentre Tradition – The Owen Three Layer Micro-Surgical Vasectomy Reversal

I have been extremely lucky to be able to pursue my passion with those who have been as equally passionate about their craft. I have succeeded Dr Bruce Errey and Dr Barry Walter’s vasectomy practices in both Brisbane and Melbourne, and continue the Owen Three Layer Closure Vasectomy Reversal technique, after extensive training under Professor Earl Owen of Sydney. I am not a gynaecologist and do not have any involvement with IVF.

Open-Ended Vasectomy Background

My passion performing micro-surgical vasectomy reversals stems from my own personal experience – the need to have a vasectomy.

My wife had developed severe varicose veins. She was placed on blood thinning injections for three months due to a blood clot in varicose veins during pregnancy, and needed to stay off the oral contraceptive pill.

I did a lot of research for my vasectomy seeing two surgeons (a general surgeon and a urologist) who both said they did not do Open Ended Vasectomies. My research led me to Professor Earl Owen who advocated this form of vasectomy (also known as the reversible vasectomy in the USA) both to minimise post vasectomy pain and maximise the chance of reversal. I had the procedure with his team.

Shortly afterwards, I turned to Professor Owen to be trained to perform this technique as many of my varicose vein patients had severe varicose veins and needed to stop the oral contraceptive pill. Professor Owen suggested that I contact the pioneer of this technique, Dr Bruce Errey in Brisbane, who had performed Professor Owen’s vasectomy and that of Dr Walters, Melbourne’s most reputed open- ended vasectomist (Both Doctors having had an open- ended vasectomy procedure with Dr Erry is common knowledge). Dr Errey, over the past 40 years, performed 30,041 open– ended vasectomies. Dr Errey trained me to perform this specialised form of vasectomy, asking me to succeed him at his retirement.

Operating on 10-15 vasectomies a week, I introduced the use of ultrasound (which I used to treat varicose veins) to assist in the assessment of pre-vasectomised patients. Using our onsite ultrasound, I have been able to assess patients presenting with anomalies in their scrotums prior to the procedures.

I have a background with microscopes in the field of ophthalmology and retinal surgery. This coupled with the fact that I have a high volume open-ended vasectomy practice and use ultrasound in my assessment of patients, caught Professor Owens’s attention – he asked me to consider trying out for a position as his successor.

Micro-Surgical Owen Three Layer Closure Vasectomy Reversal Training

My “audition” process and early training with The Microsearch Foundation of Australia’s Training Programme, involved operating on dead laboratory rats under the microscope so that Professor Owen could test me and my hands. I have worked for 10 years with some of the best micro surgeons, however had never seen anything quite like Professor Owen’s micro-surgical skills. I had heard time and time again what a perfectionist he was from those who had watched him operate, those who have had training from him and patients who were lucky to have their life and limb restored by him. I was honoured when he asked me to undertake comprehensive training with him directly at the microscope which was more than one could ever get at a weekend microsurgery course. I trained with this pioneer of micro-surgery in an intensive mode over several years. I was thrilled when he asked me to succeed his micro-surgical vasectomy reversal practice.

Professor Owen remains the worldwide father of microsurgery, pioneering and performing almost 6000 vasectomy reversal procedures, with an actual baby birth rate of 85%. He was the pioneer of the first world hand transplant in 1998, then the double arm transplant and a collaborator on the first face transplant. He was a teacher for decades to micro surgeons from all over the world, performing regular workshops. I have been introduced to the techniques that he had pioneered and perfected for 40 years, based on the work and research he performed in his world famous Microsearch institution in Sydney.

My training was personally delivered by Professor Owen, sitting opposite me at the operating microscope for 128 cases and over 240 sides, carefully watching every tiny movement of my fingers and sharing his 40 years of vast experience. This included the management of reversal of vasectomy, post vasectomy pain syndrome and performing the highly delicate epididymovasostomy (EV-bypass procedure), necessary when there is a blockage in the epididymis at the first and second section. The EV was pioneered by Professor Owen in the 70’s and is very challenging and very enjoyable to perform when required – patients are always amazed at the techniques used when I show them the footage taken during the procedure.

Professor Owen advised me that training would be completed when he felt that my hands were like watching his own fingers down the microscope. In October 2009, he retired his practice to me and is still a consultant with Metrocentre. He was delighted with the improvement we made together adding to his 40 years of work, namely;

Use of ultrasound for assessment and planning of the scrotum

Ultrasound allows visualisation of the structures in detail, and from this I am then able to map and plan the surgery, reducing my need for “exploration” during the procedure. My high resolution scanning of over 2000 sides since 2008 has enabled me to see diverse pathology and details of the micro-tubules deep within the body of the testicle, epididymis and scrotum, NOT visible with the naked eye or with the microscope. This is particularly useful for past IVF extractions and past failed vasectomy reversal attempts. The ultrasound in my hands, has allowed me to advise patients regarding the likelihood of surgical success – particularly patients who have had previous scrotal procedures and previous failed vasectomy reversals.

For example: one patient had his vasectomy 23 years ago, had two failed reversal attempts elsewhere and then had three sperm extractions through IVF. Several clinics had told him that reversal was now impossible. After careful ultrasound assessment and planning, we successfully reversed this patient – achieving a 35 million sperm per ml count nine months after our procedure, with a wound that was one (1) cm in length on both sides. His wife is currently pregnant with their baby.

For this reason we invite patients who have been told nothing can be done to reverse their vasectomy or have had failed vasectomy reversal/s to consider a second opinion

The use of the ultrasound in my personal experience and in my hands has facilitated the delivery of safe and minimally invasive Owen Three Layer Micro-surgical Vasectomy Reversals, difficult vasectomies and the management of post vasectomy congestion syndrome. Coupled with my micro-surgical training, the ultrasound has helped me assess and plan what often becomes relatively straightforward surgery once there is a clear map. This is particularly important in the following challenging cases;

• Failed vasectomy reversal/s
• Multiple IVF sperm aspirations
• Past scrotal trauma
• Past scrotal surgery (torsion, undescended testis, varicocele and hydrocoele)
• Where patients have been told that a vasectomy reversal is not possible due to the original vasectomy
• A combination of all of the above

There has been open criticism with regards to the use of ultrasound by competing surgeons, with suggestions that this is a waste of time. I respect these opinions as all surgeons try their best – open exploration has been common place during vasectomy reversal procedures for many years. With the benefit of ultrasound, I have almost completely eliminated the need to explore the scrotum during the procedure, which preserves the precious vas deferens. This subsequently reduces the risk of bleeding. To date we have never had a patient experience a scrotal haematoma after surgery. We do not routinely use drains which are often used in other practices.

Recording of all procedures:

The Owen Three Layer Closure technique is outlined in detail at every consultation using video of the surgery to demonstrate the detail. The video is not available on the internet as it is intellectual property so partners are encouraged to attend the consultation. There are however, small snippets to be seen on the website so that patients can gain perspectives about microsurgery before their visit. We encourage patients to review vasectomy reversal surgery on Google and YouTube to assist in the comparison of surgical technique as studies have clearly shown that the success of vasectomy reversal is dependent on the surgeon’s skill, technique and volume of vasectomy reversal procedures performed.

Dedicated:

We have a dedicated vasectomy reversal team consisting of the surgeon, a team of nurses, highly trained assistants and anaesthetists performing 12 to 20 cases (24 to 40 sides) per month.

Microsurgery is rewarding and thoroughly enjoyable. I welcome all challenges as I have been fortunate to combine my micro-surgical training and the use ultrasound. I have the pleasure of working with a team of experienced anaesthetists, nurses and assistants in a very friendly and relaxed environment, continuing the tradition of patient service that Professor Owen established for over 40 years.