Vasectomy - Procedure

Procedure

The traditional incision approach of vasectomy involves numbing of the scrotum with local anesthetic (although some men's physiology may make access to the vas deferens more difficult in which case general anesthesia is recommended) after which a scalpel is used to make two small incisions on each side of the scrotum at a location that allows the surgeon to bring each vas deferens to the surface for excision. The vasa deferentia are cut (sometimes a piece removed), separated and then at least one side is sealed by ligating (suturing), cauterizing (electrocauterization), or clamping. There are several variations to this method that improve healing, effectiveness and help mitigate long-term pain such as post-vasectomy pain syndrome (PVPS)

• No-Scalpel vasectomy: Also known as a "key-hole" vasectomy, in which a sharp hemostat (as opposed to a scalpel) is used to puncture the scrotum (scrotal sac). This method has come in to widespread use as the resulting smaller "incision" or puncture wound typically limits bleeding and hematomas. Also the smaller wound has less chance of infection, resulting in faster healing times compared to the larger/longer incisions made with a scalpel. The surgical wound created by the No-Scalpel method usually does not require stitch(es).
• Open-Ended vasectomy: The testicular end of the vas deferens is not sealed, which allows continued streaming of sperm into the scrotum. This method may avoid testicular pain as a result of increased back-pressure in the epididymis. Studies suggest that this method may reduce long-term complications such as Post-vasectomy pain syndrome.
• No-Needle anesthesia: Fear of needles for injection of local anesthesia is well known. In 2005, a method of local anesthesia was introduced for vasectomy which allows the surgeon to apply it painlessly with a special jet-injection tool, as opposed to traditional needle application. The numbing agent is forced/pushed onto and deep enough into the scrotal tissue to allow for a virtually pain-free surgery. Initial surveys show a very high satisfaction rate amongst vasectomy patients. Once the effects of no-needle anesthesia take effect, all other aspects of the vasectomy surgery remain the same.
• Fascial Interposition: Recanalization of the vas deferens is a known cause of vasectomy failure(s). Fascial Interposition ("FI") helps to prevent this type of failure, increasing the overall success rate of vasectomy. FI is the positioning of the prostatic "receiving" end of the vas deferens to the outside of the fascial sheath while leaving the testicular end within the confines of the fascia. The Fascia is a fibrous protective sheath that surrounds the vas deferens. This method, when combined with intraluminal cautery (one or both sides of the vas deferens), has been shown to increase the success rate of vasectomy procedures.
• Vas Irrigation: Injections of sterile water or euflavine (which kills sperm) in to the distal portion of the vas at the time of surgery brings about a near-immediate sterile (azoospermatic) condition. The use of euflavine did however, decrease time (or, number of ejaculations) to azoospermia vs. the water irrigation by itself. This additional step in the vasectomy procedure, (and similarly, fascial interposition), has shown positive results but is not as prominent in use, given the fact that few surgeons offer it as part of their vasectomy procedure.