Surgical Clip Left After Vasectomy Impedes Blood Flow to Testicle

This case involves a man who went in for vasectomy and returned the following day with testicular pain. The presumptive diagnosis was torsion so he was rushed into surgery. During surgery, doctors found an injury to the epididymis as well as a surgical clip next to the epididymis that was compromising the blood vessels. The clip was removed, but blood flow did not return after 30 minutes. Subsequently, his testicle had to be removed.

Question(s) For Expert Witness

1. What tools/techniques are used to prevent vascular injury while clipping the vas?

2. What are the most common causes of injury to the epididymis during this procedure?

3. Have you seen this complication before or reviewed a similar case?

Expert Witness Response E-097077

I perform vasectomy and vasectomy reversals weekly. The best way to prevent vascular injury is correct identification of the anatomy and to dissect the vasal artery off the vas prior to dividing/clipping the vas. Epididymal injury is very uncommon and can be caused by performing the vasectomy too proximal to the testis. I have reviewed cases for vascular complication requiring orchiectomy after vasectomy in the past.