ntkNo Scalpel Vasectomy - The Vasectomist

  • NO SCALPEL VASECTOMY

    DR DICK HAS YOU COVERED

What Is No Scalpel Vasectomy?

No Scalpel Vasectomy (NSV) may be considered a form of ‘keyhole surgery’ and was pioneered by The Chinese.

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.

Minimal trauma to the tissue 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 (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, and the end is sealed by its own covering.
  • 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

OPEN .V. CLOSED VASECTOMY

Closed Vasectomy describes the ‘testicular end’ of the tube being sealed at the time of the vasectomy.

On the other hand, open Vasectomy leaves the lower end of the tube ‘open.’ Dr Beatty is certainly able to do this for you. In fact, open vasectomy involves one less step than closed vasectomy.

An open vasectomy would fail if the upper tube was only sealed with cautery. If you think about it, an open vasectomy with just a simple seal of the upper end would be inviting the two ends to re-join. The reason that Dr Beatty is able to offer open vasectomy is that he routinely performs fascial interposition on the upper end.

Unless you ask he will perform a closed vasectomy because he believes that the failure rate of closed vasectomy combined with fascial interposition is extremely low, and that the evidence that open vasectomy reduces congestion is very much open to debate. It’s your choice, and he’ll do an open one if you believe this is better for you.

FASCIAL INTERPOSITION

What is fascial interposition? The slippery outer layer of the upper tube is sealed over the stump using a titanium clip or absorbable suture. This allows the lower end to be left open if desired.

In theory, semen can trickle out of the ‘open end’ and reduce discomfort caused by congestion.

This is a neat theory but experiments in rats show that the ‘open ends’ do seal themselves with time. Whether ‘open vasectomy’ reduces the risk of post vasectomy pain syndrome is open to debate.

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.

MINIMALLY INVASIVE VASECTOMY

What is clear is that vasectomy should be ‘minimally invasive’. 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.”

No Scalpel Vasectomy 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.

In summary, you must get a minimally invasive vasectomy!

VASECTOMY UNDER SEDATION?

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, 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.

The No Scalpel Instrument

The Left Tube

No Needle Anaesthesia

For guys who prefer a spray to a needle!

No Needle Anaesthesia is a nice service to offer guys who are looking for a vasectomy.

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

The device sprays the local anaesthetic through the skin. You’ll feel the equivalent to a ‘rubber band snap’ as it pushes through the skin. When I ask the guys ‘ what was that like’ the response is almost always ‘fine.’

Most guys opt for the non-needle anaesthesia.

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.

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Last Reviewed / Modified: 13/3/2018
First Published: 5/2/2015