The inner lumen of the vas deferens is very small. In order to see it more clearly and to assist in suture placement, we dilate the vas lumen with a vasal dilator, as seen above.
In this picture, the vasal lumen can be seen very clearly.
Suture placement can be done in 1 or 2 layers, depending on the demands of the case and the preference of the microsurgeon. Below, I am placing a 10-0 bicurve nylon suture.
Microsurgery can be very challenging and like anything else, is made better with repitition and practice. These images were produced during a practice session that I did today in anticipation of some upcoming vasectomy reversal procedures.