Vasectomy techniques

A vasectomy is a procedure that makes a man sterile, rendering the man incapable of fathering a child. In this operation, part of the tube that carries the sperm into the semen is cut and closed at the ends. This tube is called the vas deferens.

Getting to the vas deferens: No-scalpal vasectomy (NSV)

A no-scalpel vasectomy (NSV) is a simplified way of getting to the vas deferens. Popularity has increased since introduced to the West about 10 years ago.

Instead of cutting, the scrotal skin is punctured with a fine instrument. The vas is gently lifted out of the puncture site, where it is divided and blocked with cautery and small clips. This method is safe and reliable, about 8 times less likely than a traditional vasectomy to develop a hematoma or infection. There is usually little or no pain, during or after the operation.

Blocking the vas deferens

There are 2 methods to block the vas deferens:

• Closed-ended vasectomy involves closing both the testicular end and the prostatic end of the vas.
• Open-ended vasectomy blocks only the prostatic end and leaves the testicular end open. This is said to result in fewer cases of chronic pain.

Evidence now suggests that the open-ended closure is preferable. It has no higher failure rate, has less incidence of pain, and is more often successful if reversed.

Techniques of blocking the vas can vary from surgeon to surgeon. The following are examples of various blocking techniques that can be combined or used alone:

• Removal of a short segment of the vas.
• Crimping the ends of the vas closed with small metal artery clips.
• Sealing the ends with heat or electric cautery.
• Stitching the ends closed.
• Fascial interposition. The fascia is the sheath surrounding the vas. A cut end of the fascia is sewn over one end of the vas, forming a tissue barrier between the ends.

A historical overview of NSV

• NSV was developed in Chongking, China in 1974 by Dr. S. Li.
• In 1985 an American-led team of urologists went to study the procedure who became convinced of its benefits over conventional techniques.
• In 1988 they conducted a study in Bangkok, performing 1,200 vasectomies in one day at the King's Birthday Vasectomy Festival. 600 of the vasectomies were performed via the NSV technique and had roughly one-eighth the complications of the other 600 that were performed traditionally.

How effective is NSV?

Over 99% of these operations are successful. In rare cases, sperm manages to "recanalize" an opening around the blockage. It is important to use alternative birth control until the semen is checked to make sure the operation has worked successfully, about 6 weeks post-operation. If the semen is clear of sperm, you get the green light to stop birth control.

It is recommended to get a second semen sample approximately a month later for extra assurance that recanalization has not occurred.