What is evidence based surgery?

The Vasectomy Reversal Centre bases all of its treatment on the philosophy of “evidence based surgery”. What does this mean? It’s important to spell this out, as there is a lot of questionable information around, and vasectomy reversal is obviously a controversial and emotive subject.Put as simply as possible, evidence based surgery is the practice of basing a choice of surgical technique on the evidence from the published medical literature on success rates.Mr Harriss is a highly experienced specialist surgeon, with over 17 years of performing literally thousands of vasectomy reversal operations. He currently performs around 500 vasectomy reversals a year, whereas 75% of UK urological surgeons perform fewer than 15, according to a medical study. It might be thought natural, then, that he might carry out reversal of vasectomy surgery solely based on his own clinical experience.

This is not enough, though. Personal experience, however much of it you have, has to be supported by evidence from medical science. Mr Harriss makes choices based on the huge medical literature on vasectomy reversal surgery, and chooses techniques based on the evidence of which ones have the highest vasectomy reversal success rate. This means ignoring a number of supposed “gold standard” surgical techniques which are not supported by evidence.

For example, multiple studies have shown there is no evidence that multi-layer techniques for rejoining the vas deferens are superior to single-layer techniques. Mr Harriss uses the single layer technique, and uses a variable number of sutures depending on the anatomy, rather than a large number of smaller sutures. There are plenty of people on web forums who believe that multi-layer is necessarily better, or that there is some “standard” number of sutures; this is not what the medical literature says.

The literature also does not find any benefit from carrying out sperm harvesting at the time of the operation. Since this additional procedure complicates the operation and increases its cost for no provable benefit, Mr Harriss advises against it (although it can be arranged if this is what you want).

Our commitment to evidence based surgery is borne out by our own practice in publishing audited data on vasectomy reversal success rates. Our vasectomy reversal clinic in Nottingham aims to be a leader in best practice.