No Scalpel Vasectomy
No Scalpel Vasectomy – The Technique & Benefits.
What Is No Scalpel Vasectomy?
A No Scalpel Vasectomy (NSV) may be considered a form of ‘keyhole surgery.’
Traditional vasectomy requires incisions and stitches on both sides. The No scalpel method, however, requires a single small incision at the front of the scrotum. Because the incision is shallow, no stitches are needed and healing time is minimal.
Lack of complicated surgery means that you can return to work and physical activities sooner.
From Start To Finish
- You go from the consultation room to the procedure room.
- You’re asked to remove your shoes and lie on the couch. You put on a hot water bottle to relax the scrotal muscles.
- The electric couch lifts to the correct height, and the doctor asks you to lower your clothes to your shins.
- The doctor does the “wash down” with warmed antiseptic solution. A small amount of local anaesthetic is applied.
- The doctor starts with the left side with a specialised instrument that is applied to the left tube.
- The left tube is electro-cauterised and separated.
- The right tube is brought up through the same small hole.
- The procedure is completed on the right side.
- A small dressing is applied and you have some recovery time.
The vasectomy gallery
Created by Dr Dick Beatty
WHAT DO THE LEADING VASECTOMY GUIDELINES HAVE TO SAY?
The UK’s internationally-respected Faculty of Sexual & Reproductive health care guideline (FSRH 2014) states that “a minimally invasive approach should be used to expose and isolate the vas deferens during vasectomy as this approach results in fewer early complications in comparison to other methods.”
NSV is recommended above traditional vasectomy in The American Urological Association Vasectomy Guideline which specifically states in their amended 2015 guideline that “Minimally Invasive Vasectomy should be used for Vas Isolation.” The European Association of Urology Guidelines on Vasectomy guideline (2012) states the same.
Dr Beatty employs intraluminal cautery (Inline Vasectomy) to close the tubes. This is a form of ‘closed vasectomy.’ There is no clear evidence that ‘open vasectomy’ is superior to ‘closed’ vasectomy. Inline Vasectomy is one of the three methods equally recommended in the AUA guideline (AUA 2015 – P.21, guideline statement 7.2) & other guidelines above (FSRH/EAU). Dr Beatty used to perform ‘open’ vasectomy but gets better results with ‘closed’ vasectomy that has the advantage of avoiding any sutures.
SHOULD VASECTOMY BE PERFORMED UNDER SEDATION?
A vasectomy is usually performed under local anaesthetic without sedation. Local anaesthetic vasectomy is safe, quick and painless. The 2015 national US Vasectomy guideline makes a positive recommendation that local anaesthetic is routine used: “Vasectomy should be performed with local anesthesia with or without oral sedation” (statement 5).
In The UK, almost all vasectomies are performed under local anaesthetic, and audit results from the primary care surgical association show very high levels of satisfaction.
There are very few patients who are not nervous about having a vasectomy. Thankfully, the vast majority say the procedure was nothing like they thought it would be.
Sedation is probably better suited to the minority who are particularly anxious. Full sedation requires an anaesthetist and is usually performed in a hospital setting.
Our Local Anaesthetic Technique
An ultra-fine hypodermic needle is used to insert a small bleb of local anaesthetic just under the skin whilst the skin is stretched to reduce any discomfort. More local anaesthetic is then infiltrated around the actual tubes.
What Sort of needle do you use?
The Vasectomist sources the ultra-fine 32G needle from overseas.
See this needle comparison chart. The diameter of a 32G needle is 0.2 mm which is considerably finer than a needle used for taking blood or giving a vaccine.
The 32G causes minimal to no discomfort and, in Dr Beatty’s opinion, gives the same results as the so-called needle-free anaesthetic. Bear in mind that the 32G needle is the same diameter as that used by kids for their daily diabetes needles, and it is more likely that you feel the anaesthetic going in rather than the needle itself.
