No-scalpel vasectomy

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No-scalpel vasectomy
Other namesNon-scalpel vasectomy, NSV, Keyhole vasectomy
Specialty Urology, Family Medicine, General Surgery

No-scalpel vasectomy (also called non-scalpel vasectomy, keyhole vasectomy or NSV) is a type of vasectomy procedure in which a specifically designed ringed clamp and dissecting hemostat is used to puncture the scrotum [1] to access the vas deferens. This is different from a conventional or incisional vasectomy where the scrotal opening is made with a scalpel. The NSV approach offers several benefits, including lower risk for bleeding, bruising, infection, and pain. [1] The NSV approach also has a shorter procedure time than the conventional scalpel incision technique. [1] Both approaches to vasectomy are equally effective. Because of the inherent simplicity of the procedure it affords itself to be used in public health programs worldwide. This method is used in over 40 countries for male sterilisation. [2]

Contents

History

No-scalpel vasectomy was developed and first performed in China by Dr. Li Shunqiang with the aim of reducing men's fear related to the incision and increasing vasectomy use in China. [3] In 1985, a team created by EngenderHealth visited his centre to learn the technique. [3] One of the team members, Dr. Phaitun Gojaseni, introduced the no-scalpel technique in Thailand upon his return, while another member of the team, Dr. Marc Goldstein, introduced the technique to the United States at the NewYork–Presbyterian Hospital. Over time, the technique gained popularity and it is now a preferred method of male sterilization in many countries. [3]

History of no-scalpel vasectomy in India

No-scalpel vasectomy was introduced in India in 1998. A team of Indian surgeons led by Dr RCM Kaza travelled to Chengdu, China, to learn the technique under the aegis of EngenderHealth and the UN. They then introduced the procedure in India, under the National Rural Health Mission. The Government of India then proceeded to introduce the procedure in every district of India as an alternative to tubal ligation offered to women.[ citation needed ]

World Vasectomy Day is celebrated on 7 November in India. [4]

Technical procedure

No-scalpel vasectomy is a day case (outpatient) procedure and the patient is fit to go home the same day. [5]

The eligibility criteria for the no-scalpel vasectomy and the conventional vasectomy procedure are the same, although may vary from clinic to clinic.

Anaesthesia

No-scalpel vasectomy is performed under local anaesthesia. Usually lidocaine 2 percent is infiltrated into the vas deferens and the puncture site on the scrotum. This makes the procedure pain free. Some patients may prefer to receive regional anaesthesia.[ citation needed ]

Steps

The vas deferens is isolated by three-finger technique on both sides. The ideal entry point for the needle is midway between the top of the testes and the base of the penis. Usually, 100 mg lidocaine (without epinephrine) is injected to create a wheal. The no-scalpel vasectomy uses two specific instruments designed by Dr. Li Shunqiang. One is a ringed clamp and the other is a dissecting forceps. The ringed clamp is used to isolate and encircle the vas. The dissecting forceps is used to puncture the scrotal skin, spread tissues, and pierce the vas deferens to deliver it outside the scrotum. The vas deferens is then occluded. [3]

Methods of occluding the vas deferens

The most commonly used methods to occlude the vas deferens include: [6]

  • Fascial interposition or burying one end of the cut vas deferens under tissue
  • Folding back or folding and tying each end of the vas deferens so they do not face one another
  • Tying with either sutures or clips
  • Cauterising of one or both ends

The American Urological Association recommends occlusion by one of the following methods to achieve highest efficacy: [6]

  • Cautery with or without fascial interposition
  • Open ended vasectomy with one end of the vas open; the other end with cautery and fascial interposition
  • Extended electrocautery

Complications

No-scalpel vasectomy has less pain, bleeding and infection than conventional vasectomy. [1] No-scalpel vasectomy can also be done in less time and the individual is able to return to sexual activity sooner than traditional vasectomy surgery. [1] However, sperm may still be present for 10–20 ejaculations, and some doctors may schedule a follow-up visit to confirm the success of the procedure. Additionally, there is approximately a 1 in 2,000 chance of pregnancy following a vasectomy, as some sperm may be able to cross the severed vas deferens. [5]

Complications are rare and can include: [7]

Related Research Articles

<span class="mw-page-title-main">Vasectomy</span> Surgical procedure for male sterilization

Vasectomy, is an elective surgical procedure for male sterilization or permanent contraception. During the procedure, the male vasa deferentia are cut and tied or sealed so as to prevent sperm from entering into the urethra and thereby prevent fertilization of a female through sexual intercourse. Vasectomies are usually performed in a physician's office, medical clinic, or, when performed on an animal, in a veterinary clinic. Hospitalization is not normally required as the procedure is not complicated, the incisions are small, and the necessary equipment routine.

Sterilization is any of a number of medical methods of birth control that intentionally leaves a person unable to reproduce. Sterilization methods include both surgical and non-surgical, and exist for both males and females. Sterilization procedures are intended to be permanent; reversal is generally difficult or impossible.

<span class="mw-page-title-main">Tubal ligation</span> Surgical clipping,removal or blocking of the fallopian tubes

Tubal ligation is a surgical procedure for female sterilization in which the fallopian tubes are permanently blocked, clipped or removed. This prevents the fertilization of eggs by sperm and thus the implantation of a fertilized egg. Tubal ligation is considered a permanent method of sterilization and birth control.

Cauterization is a medical practice or technique of burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undesired growth, or minimize other potential medical harm, such as infections when antibiotics are unavailable.

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Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure. However, a sore throat is common.

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<span class="mw-page-title-main">Vas-occlusive contraception</span> Form of male contraception that blocks sperm transport in the vas deferens

Vas-occlusive contraception is a form of male contraception that blocks sperm transport in the vas deferens, the tubes that carry sperm from the epididymis to the ejaculatory ducts.

Vasovasostomy is a surgery by which vasectomies are partially reversed. Another surgery for vasectomy reversal is vasoepididymostomy.

<span class="mw-page-title-main">Instruments used in general surgery</span>

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<span class="mw-page-title-main">Testicular sperm extraction</span>

Testicular sperm extraction (TESE) is a surgical procedure in which a small portion of tissue is removed from the testicle and any viable sperm cells from that tissue are extracted for use in further procedures, most commonly intracytoplasmic sperm injection (ICSI) as part of in vitro fertilisation (IVF). TESE is often recommended to patients who cannot produce sperm by ejaculation due to azoospermia.

Ambulatory phlebectomy is a minisurgical treatment for superficial varicose veins and so-called side branches.

Post-vasectomy pain syndrome (PVPS) is a chronic and sometimes debilitating genital pain condition that may develop immediately or several years after vasectomy. Because this condition is a syndrome, there is no single treatment method, therefore efforts focus on mitigating/relieving the individual patient's specific pain. When pain in the epididymides is the primary symptom, post-vasectomy pain syndrome is often described as congestive epididymitis.

<span class="mw-page-title-main">Sperm granuloma</span> Lump of extravasated sperm found in some vasectomized men

A sperm granuloma is a lump of leaked sperm that appears along the vasa deferentia or epididymides in vasectomized individuals. While the majority of sperm granulomas are present along the vas deferens, the rest of them form at the epididymis. Sperm granulomas range in size, from one millimeter to one centimeter. They consist of a central mass of degenerating sperm surrounded by tissue containing blood vessels and immune system cells. Sperm granulomas may also have a yellow, white, or cream colored center when cut open. While some sperm granulomas can be painful, most of them are painless and asymptomatic. Sperm granulomas can appear as a result of surgery, trauma, or an infection. They can appear as early as four days after surgery and fully formed ones can appear as late as 208 days later.

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Vasectomy reversal is a term used for surgical procedures that reconnect the male reproductive tract after interruption by a vasectomy. Two procedures are possible at the time of vasectomy reversal: vasovasostomy and vasoepididymostomy. Although vasectomy is considered a permanent form of contraception, advances in microsurgery have improved the success of vasectomy reversal procedures. The procedures remain technically demanding and may not restore the pre-vasectomy condition.

Reproductive surgery is surgery in the field of reproductive medicine. It can be used for contraception, e.g. in vasectomy, wherein the vasa deferentia of a male are severed, but is also used plentifully in assisted reproductive technology. Reproductive surgery is generally divided into three categories: surgery for infertility, in vitro fertilization, and fertility preservation.

Vasoepididymostomy or epididymovasostomy is a surgery by which vasectomies are reversed. It involves connection of the severed vas deferens to the epididymis and is more technically demanding than the vasovasostomy.

In surgery, a surgical incision is a cut made through the skin and soft tissue to facilitate an operation or procedure. Often, multiple incisions are possible for an operation. In general, a surgical incision is made as small and unobtrusive as possible to facilitate safe and timely operating conditions.

Circumcision surgical procedure in males involves either a conventional "cut and stitch" surgical procedure or use of a circumcision instrument or device. In the newborn period, almost all circumcisions are done by generalist physicians using one of three surgical instruments. In the US, the Gomco clamp is the most utilized instrument, followed by the Mogen clamp and the Plastibell. They are also used worldwide.

<span class="mw-page-title-main">Surgery in ancient Rome</span>

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References

  1. 1 2 3 4 5 Cook, Lynley A.; Pun, Asha; Gallo, Maria F.; Lopez, Laureen M.; Van Vliet, Huib A. A. M. (30 March 2014). "Scalpel versus no-scalpel incision for vasectomy". The Cochrane Database of Systematic Reviews. 2014 (3): CD004112. doi:10.1002/14651858.CD004112.pub4. ISSN   1469-493X. PMC   6464377 . PMID   24683021.
  2. Shattuck, Dominick; Perry, Brian; Packer, Catherine; Chin Quee, Dawn (23 December 2016). "A Review of 10 Years of Vasectomy Programming and Research in Low-Resource Settings". Global Health: Science and Practice. 4 (4): 647–660. doi:10.9745/GHSP-D-16-00235. ISSN   2169-575X. PMC   5199180 . PMID   28031302.
  3. 1 2 3 4 No-Scalpel Vasectomy: An Illustrated Guide for Surgeons (PDF). New York: Engender Health. 1997. Retrieved 17 November 2016.
  4. "World Vasectomy Day" (PDF).
  5. 1 2 "A Urologist Answers Questions About the No-Needle, No-Scalpel Vasectomy". UNC School of Medicine . 1 June 2019. Retrieved 22 April 2022.
  6. 1 2 Sharlip, Ira D.; Belker, Arnold M.; Honig, Stanton; Labrecque, Michel; Marmar, Joel L.; Ross, Lawrence S.; Sandlow, Jay I.; Sokal, David C. (December 2012). "Vasectomy: AUA Guideline". Journal of Urology. 188 (6S): 2482–2491. doi:10.1016/j.juro.2012.09.080. ISSN   0022-5347. PMID   23098786.
  7. "Complications of No-scalpel vasectomy". drvijayantgovinda.com. 25 September 2016.