ntkNo Scalpel Vasectomy - The Vasectomist

  • VASECTOMY CONCEPTS

    NO SCALPEL, OPEN ENDED, FASCIAL INTERPOSITION

All is revealed in The Video

THE TERMINOLOGY

No Scalpel Vasectomy

Think of No Scalpel Vasectomy (NSV) as simply a way of ‘getting to’ the tubes via a single small hole in the middle.

The Tubes

The Vas Deferens, or simply ‘The Vas.’ Sperm swim from the testicle up through The Vas to the base of the bladder.

Upper End & Lower End

Each of the two tubes is divided, leaving two ends.

The Upper end is the end nearest the groin. The Lower end is the end nearest the testicle.

Vasectomy Doctors refer to The upper end as The Abdominal end, and The Lower end as The Testicular end.

Open Ended Vasectomy

The lower end is left open.

The Fascia

Fascia, sounding like ‘Fasha,’ is the strong thin layer of connective tissue that lies just outside of the tubes.

Fascial Interposition

The fascia covers the stump of one end whilst the other end is left outside the fascia.

VASECTOMY WHITEBOARD

NO SCALPEL + FASCIAL INTERPOSITION + OPEN ENDED

WHAT IS A NO SCALPEL VASECTOMY?

No Scalpel Vasectomy (NSV) is the predominant form of ‘minimally invasive’ vasectomy. Traditional vasectomy requires incisions and stitches on both sides. NSV leaves a small 2-3mm hole at the front of the scrotum. No stitches are required, and healing time is minimal. Minimal trauma to the tissue means that you can return to work and physical activities sooner.

Do we really need guidelines to confirm that vasectomy should effectively be gentle? Maybe not, but it’s comforting to know that The UK Vasectomy 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 also 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) adds to the consensus.

YOUR VASECTOMY OPTIONS

How many vasectomies in Australia are performed in the traditional way with a scalpel on both sides? There are no figures, but they still are certainly performed this way. Dr Dick Beatty’s hunch is that over 80% of vasectomies in Australia are nowadays performed using the NSV method.

No Scalpel Vasectomy simply describes the way to ‘get to’ the tubes – no more, and no less. You will want to know how the tubes are blocked, so let’s move onto the other vasectomy buzz word: Occlusion.

What really separates one vasectomist from another is the method of occlusion

Let’s move onto the nuts and bolts of vasectomy:

  • Open or Closed Vasectomy
  • Fascial Interposition (FI)
  • Clips or Suture

Finally, we’ll finish off with a look at no-needle anaesthesia.

OPEN .V. CLOSED VASECTOMY

So the tube has been divided, leaving an upper end and a lower end. Do you now block the upper end, the lower end, or both? This is where things get a little convoluted. Dr Dick Beatty gets out the whiteboard with three scenarios:

You block the lower end, leaving the upper end open

The lower end is blocked, the sperm have ‘nowhere to go’, so this is called a closed vasectomy. ‘Closed Vasectomy’ means that the lower end is blocked.

The concern with closed vasectomy is that the sperm have ‘nowhere to go’ and may lead to discomfort caused by congestion.

You block both ends

Closed Vasectomy also results from blocking both the upper end and the lower ends and is the most common form of closed vasectomy. Heat in the form of electrocautery may be used on its own to seal tube (this is done before the tube is divided).

You can’t cauterise just one end and leave the other open, or the tubes have a 10% risk of growing back. When heat is used on its own, you therefore ‘have to’ seal both ends. In The UK, you get a closed vasectomy.

You block the upper end, leaving the lower end open

Sperm may be considered free to swim from the testicle, up the tube and through the open end. This scenario describes an ‘Open Vasectomy.’

We’ve just said that cautery of just one end does not work so what other method of occlusion is used in an open vasectomy? The answer is Fascial Interposition.

FASCIAL INTERPOSITION

Fascial Interposition (FI)  is regarded by many Vasectomists as the holy grail of vasectomy technique.

Thankfully, the tube has a thin slippery outer layer called fascia. The fascia is gently pulled over the stump and kept in place with a titanium clip or absorbable suture.

The aim of FI is to improve the success of vasectomy, and to allow for an open vasectomy. FI only needs to be performed up the upper end so that the lower end may be left open.

Does open vasectomy with FI result in less discomfort? The theory goes that sperm swim out of the lower tube after an open vasectomy. Honestly, no one knows if this is true. An experiment in rats demonstrated that the tubes left open do in fact seal themselves closed within a few weeks of a vasectomy. In all honesty, an open vasectomy is probably closed within a few weeks.

Is discomfort reduced after an open vasectomy? Studies are also not conclusive which is the reason that the main international guidelines do not advocate that open is better than closed vasectomy.

Dr Dick Beatty performs fascial interposition, and routinely seals both ends. The lower end is sealed very gently in the hope of reducing the failure rate to the absolute minimum.  He is certainly happy to keep the lower end open for guys who request an open vasectomy. This shortens the procedure by a few seconds but the vasectomy is otherwise identical.

How is the fascia sealed? A titanium clip works nicely but you may request an absorbable suture if you prefer. It’s down to personal preference. The clip is used by default simply because of excellent coverage of the stump. The 2mm clip is MRI friendly and doesn’t bleep in airports!

Let Dr Beatty know if you have a preference for open or closed, clip or suture.

NO NEEDLE ANAESTHESIA

For guys who prefer a spray to a needle!

Let’s face it, most guys don’t want a needle ‘down there!’

The no-needle device sprays the local anaesthetic through the skin. You’ll feel the equivalent to a ‘rubber band snap’ as the device sprays the xylocaine through the skin. Guys asked  “what was that like?’ usually respond with “fine.”

You don’t have to have the no-needle method. Indeed, The Vasectomist believes the benefit of no-needle anaesthesia is mostly for guys who are needle phobic.

Let’s check out the equally good fine needle-anaesthesia option.

FINE NEEDLE ANAESTHESIA

Another option For the guys who prefer a needle!

The ultra-fine 33G needle is ridiculously fine (and short) and is sourced from overseas. This achieves great anaesthesia.

See this needle comparison chart. The diameter of a 33G needle is 0.2 mm which is considerably finer than a needle used for taking blood or giving a vaccine.

The 33G causes minimal to no discomfort.  Bear in mind that the 33G 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.

VASECTOMY UNDER SEDATION?

Full sedation is a ‘general anaesthetic’ (GA) requiring an anaesthetist with access to the full paraphernalia of emergency care. A vasectomy rarely needs to be performed under sedation.

Local anaesthetic vasectomy using no-needle anaesthesia 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, vasectomy under GA is almost unheard of. Satisfaction with local-anaesthetic vasectomy is very high.

There are very few patients who are not nervous about having a vasectomy. However, there are lots of ways to reduce anxiety – and a GA is, in Dr Beatty’s opinion, a last resort for guys who have extreme anxiety. GA is also suited for guys with challenging anatomy because the testicles drop by around 2cm during a general anaesthetic. The pre-vasectomy consultation will pick up any issues requiring a referral for vasectomy under a general anaesthetic.

FROM START TO FINISH

  • You go from the consultation room to the procedure room.
  • You’re asked to (only) remove your shoes and lie on the couch at this stage! A hot water bottle is applied.
  • 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.
  • You have the choice of ‘no needle anaesthesia’ or ‘fine needle’ anaesthesia.
  • The doctor starts with the left side with a specialised instrument that is applied to the left tube.
  • The left tube is electro-cauterised, separated
  • The upper ‘stump’ is sealed with its own covering (fascial interposition).
  • The right tube is brought up through the same small hole & the procedure repeated on the right side.

The vasectomy gallery

Created by Dr Dick Beatty

Vasectomy Anatomy for Men

Gives you idea, but you are covered up!

Ultrafine 33g Needle

The No Scalpel Instrument

The Left Tube

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Dr Beatty
Last Reviewed / Modified: 13/3/2018
First Published: 5/2/2015
Contraception vasectomy and contraception