Previous studies have shown that robot-assisted microsurgical vasovasostomy (RAVV) has technical advantages over pure microscopic vasovasostomy (MVV) in animal and human models. This study presents a video technique and initial results for RAVV in 20 human cases compared with 7 MVV cases by a single fellowship-trained microsurgeon from July 2007 to June 2009. A three-layer 10-0 and 9-0 suture anastomosis was performed with up to 22 months follow-up (mean 3 months). Mean operative duration for the RAVV cases was 109 and 128 minutes for MVV (p = 0.09). At 2 months postoperatively, all patients were patent. Mean sperm count was 54 million in RAVV and 11 million in MVV (p = 0.04). The use of robotic assistance in microsurgical vasovasostomy may have potential benefit over MVV in decreasing operative duration and significantly improving early semen analysis measures. Further evaluation and longer follow-up is needed to assess its clinical potential.