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No Scalpel Vasectomy

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Updated April 27, 2012

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No Scalpel Vasectomy

No Scalpel Vasectomy

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During a standard vasectomy, two incisions are made in the scrotum to allow the surgeon to reach each of the man’s vas deferens (the two tubes that transmit sperm into the semen). During a no scalpel vasectomy (also referred to as a keyhole vasectomy), no incisions are made. Instead, the surgeon uses a hemostat (locking forceps with a sharp tip) to puncture through the skin of the scrotal sac. Then, the skin is gently spread only until both vas deferens can be visualized. Because the puncture site is so small and is just through the skin, stitches are usually not required and healing time is quick. As compared to a traditional vasectomy, the no scalpel approach is a less invasive and quicker procedure (total time including prep and anesthesia is approximately 15 to 20 minutes).

The general feeling in the medical community is that there should be more of a push to perform no scalpel vasectomies instead of conventional ones. There are clear advantages to this technique that support that the incisional approach be discarded. The implication of a less invasive, no scalpel procedure can be tempting to more men. This allows men the opportunity to take on a greater role in their contraceptive responsibility. Since the history of family planning has focused more on women (because it is their health that is directly affected by pregnancy and childbirth), providing men with an appealing and highly effective contraceptive option broadens their limited choices when it comes to birth control options. When presented with the less “menacing” option of being able to have a vasectomy without a scalpel, men may become reintegrated into contraceptive decisions for their families and relationships and may choose to bear the responsibility for contraception.

The No Scalpel Vasectomy Procedure:

The goal during a no scalpel vasectomy (or keyhole vasectomy) is the same as for a conventional vasectomy -- to create a blockage in the vas deferens, so that sperm can no longer become part of the semen. This is done by cutting off a short piece of the vas deferens, removing it, and then ligating (tying-off), clipping or cauterizing (burning) the remaining vas ends. During a no scalpel vasectomy, each vas (one at a time) is actually lifted out of the single puncture site, and then the occlusion is performed. Some surgeons may take the additional step of fascial interposition which consists of sewing connective tissue over the free prostatic end of vas (the end closest to the urethra). This creates a tissue barrier between the vasal ends. Some research suggests that this additional step decreases failure rates, but the evidence is inconclusive at this time. Then, each end of the vas are allowed to slip back into the scrotum.

During a traditional vasectomy, men may be given the choice to have an “open-ended” procedure. This means that only the prostatic end of vas is tied or cauterized. The testicular end (closest to the testis) is left open. The reason for keeping this end open is to allow for sperm leakage. No scalpel vasectomies also allow for this open-ended option. Some research has shown that allowing for this leakage prevents the thickening or build-up of sperm because the sperm can flow into and be absorbed by the scrotum. This, in turn, can lead to less pressure -- the potential cause of post-vasectomy pain. The open-ended technique has also been shown to lower complication rates as well as fewer cases of epididymitis (when the epididymis tube at the back of the testicle responsible for storing and carrying sperm becomes inflamed).

Research demonstrates that men who underwent the no scalpel vasectomy reported overall satisfaction in their sexual lives and being able to quickly resume having intercourse, positive postoperative psychological statuses, nominal postoperative pain, few post-procedure complications and quick recovery times. This lends more support for the notion that the no scalpel vasectomy is a simplified approach to vasectomy. This minimally invasive procedure offers the straightforwardness of a traditional vasectomy while offering many additional benefits.

Advantages of the No Scalpel Vasectomy:

  • Men may be more willing to seek this procedure because it sounds more appealing
  • Less invasive
  • Sexual activity may be resumed as soon as you feel comfortable
  • No stitches or scarring
  • 40-50% quicker recovery with little pain
  • Doesn't lower sex drive
  • Less chance for bleeding complications
  • Long-term, discreet contraceptive option
  • Highly effective
  • Lower risk of infection (due to smaller wound, no long incision)

Disadvantages:

  • Still considered a surgical procedure (but is done on an outpatient basis)
  • It requires hand-on training and lots for practice before surgeons gain proficiency in this technique
  • Because sperm may still be present in the vas beyond the point of occlusion, this procedure requires men to use a back-up method of birth control for the first 15 to 20 ejaculations (or about 12 weeks) after the procedure
  • Offers no protection against sexually transmitted infections or HIV
  • Must schedule an additional doctor’s visit to make sure that there are no more sperm present in your semen
  • Right now, tubal ligation is the more popular permanent choice. Around the country, more doctors need to become trained in this simple vasectomy technique, offer it to their patients and increase men’s awareness of this no scalpel option. For this reason, it may be harder to find a skilled surgeon.

Potential Side Effects:

Typically, a no scalpel vasectomy does not have any major side effects and is only linked to a very small chance of infection and little pain. You may experience a reaction to the local anesthesia. Some men report short-term tenderness and a little bit of bruising after the procedure. There is a tiny chance of developing sperm granuloma -- a hard, sometimes painful pea-sized lump due to the sperm leaking out from the open-ended vas deferens. The lump is not dangerous, rarely symptomatic and is almost always resolved by the body in time. Plus, it may actually serve a protective feature to the testis and epididymis. The granuloma is rich in epithelial-lined channels that may vent leaking sperm away from the epididymis and protect against increased pressure from sperm blockage.

No Scalpel Vasectomy Costs:

In general, vasectomies are considered a lower-cost surgical option. You may be charged for an initial consultation as well as for your follow-up visit to have your semen analyzed. But, after these up-front costs, there are no ongoing costs to maintain this contraceptive method. This procedure is covered by many private insurance plans. Without insurance, depending on your geographical location and the facility you choose to use, a no scalpel vasectomy will typically cost between $500 to $1,000 (some facilities will bundle all of your visits into one price while others may charge for each individually).

Effectiveness:

The no scalpel vasectomy is extremely effective - 99.85% to 99.9% effective, but this is based on the man using back-up birth control until he has been cleared by the doctor that there are no sperm left in his semen. So, this means that less than 1 out of 100 women whose partners have had a no scalpel vasectomy will get pregnant each year.

Of special note, the no scalpel vasectomy is not 100% guaranteed to be effective. Even when the procedure is performed perfectly, the possibility for recanalization can occur. This is when sperm manage to find their way across the blocked ends of the vas deferens. The possibility of this occurring is very rare (less than 0.2% of the time). Recanalization generally happens in the first 2 to 3 months after the no scalpel vasectomy (incidence 1/500), but it can even occur years after the procedure (though extremely rare, with an incidence 1/4,500). This is why it is extremely critical that you undergo your semen analyses 6-12 weeks post-vasectomy to be absolutely sure that no sperm are present.

A Final Note About No Scalpel Vasectomy:

This procedure is intended to be permanent. Though vasectomy reversal procedures are available, they are technically complex, expensive, and have variable success rates. You should only choose to seek a no scalpel vasectomy if you are sure that you no longer want to have children. Don’t go into the decision thinking, in the back of your mind, that you could always reverse it if your circumstances or thoughts change. This procedure is intended for those men who feel 100% confident that this is what they want as their contraceptive choice... for the rest of their lives.

Sources:

Anthony Viera, Timothy Clenney. “Vasectomy and other vasal occlusion techniques for male contraception.” UpToDate. Accessed via private subscription 9/9/11.

David K. Turok, Grace Shih, Willie J. Parker. “Reversing the United States sterilization paradox by increasing vasectomy utilization.” Contraception 2011;83:289–290. Accessed via private subscription 9/9/11.

EngenderHealth. (2003). “No-scalpel vasectomy: An illustrated guide for surgeons” (3rd ed.). Automated Graphic Systems, Inc: NewYork. Accessed 9/9/11.

Errey BB, Edwards IS. “Open-ended vasectomy: An assessment.” Fertil Steril. 1986;45(6):843. Accessed via private subscription 9/9/11.

Kuan-Chou Chen, Chiung-Chi Peng, Hsiu-Mei Hsieh, Han-Sun Chiang. “Simply modified no-scalpel vasectomy (percutaneous vasectomy) — A comparative study against the standard no-scalpel vasectomy.” Contraception 2005;71(2): 153-156. Accessed via private subscription 9/9/11.

Labrecque M, Nazerali H, Mondor M, Fortin V, Nasution M. “Effectiveness and complications associated with 2 vasectomy occlusion techniques.” J Urol. 2002;168(6):2495. Accessed via private subscription 9/9/11.

Li SQ, Goldstein M, Zhu J, Huber D. “The no-scalpel vasectomy.” J Urol. 1991;145(2):341. Accessed via private subscription 9/9/11.

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