THE NO-SCALPEL PROCEDURE

 
The concept of vasectomy probably originated in the later 19th Century but didn’t see wide-spread use until the 40’s. In 1974 Dr. Li of the Sichuan Province of China developed a significant advancement in the surgical technique of accessing the vas deferens (“vas”) (the tubular duct that carries sperm from the testicles to the urethra). It took eleven years for Dr. Li’s techniques to make their way to the United States when Dr. Goldstein of New York performed the first no-scalpel vasectomy in the U.S in 1985. Since then the popularity of vasectomy has increased steadily although many would say that it is still under utilized. 
No scalpel vasectomy involves the use of two specially designed surgical instruments which are used to fixate the vas approximately half-way between the top of the testicle and the base of the penis, and then puncture through the scrotal skin with sharp forceps to both create a scrotal opening and then deliver the vas through the small opening to the outside where it can be manipulated.
The technique of no-scalpel vasectomy involves only the delivery of the vas to the outside of the scrotum. What happens next varies widely from surgeon to surgeon. However, the next step is to occlude the vas in some fashion to block the flow of sperm.
There are many variations on the approach of occluding the vas. The various methods generally include two or more of the following strategies:
  • Cutting and excising a section of each vas.
  • Cauterization of either the ends of the cut stumps or the inner lumen of the one or both sides of each vas.
  • Ligation (crimping off) of one or both sides of each vas by suture or metal clip.
  • Fascial Interposition (sewing one end inside, and one end outside, of the vasal sheath)
Another variation includes the leaving of the testicular end left of the vas open to avoid epididymal back-pressure. This strategy can be combined with any of the above but almost always is combined with fascial interposition. There is wide differences in the effectiveness and complication profiles of these different approaches so it is important to understand the advantages and disadvantages of each approach and then ask your doctor which approach he uses. 

 Back Next