Vasectomy and Vasovasostomy - Surgery

No-Scalpel Vasectomy (NSV)

A method of vasectomy called no-scalpel vasectomy (NSV) that does not require the use of a scalpel was developed in China in 1974. NSV is now used in at least one-third of vasectomies.

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The technique takes about 10 minutes and is performed in a doctor''s office or a family planning clinic. The no-scalpel vasectomy (NSV) differs from a conventional vasectomy in the method of accessing the vasa deferentia:

In NSV, the doctor feels for the vas deferens under the skin and holds them in place with a small ring clamp.
Instead of making two incisions, the doctor employs a sharp hemostat, a special instrument that makes one tiny puncture and then is used to gently stretch the opening until the vas deferens can be pulled through it. (The surgeon must rotate his wrist to pull the vas out--called a supination maneuver--which may be difficult to perform.)
The vas is then sealed off using the same methods (clips, sutures, cauterization using an electric needle, or some combination) as conventional vasectomy. As with standard vasectomy, the closures can be open- or closed-ended.
There is very little bleeding with the no-scalpel vasectomy. No stitches are needed to close the tiny opening, which heals quickly and leaves no scar.

When performed correctly, NSV works just as well as conventional vasectomy and takes less time. Current research indicates that NSV is the safest type of vasectomy procedure. NSV is difficult to perform, however, and most surgeons must perform about 15 to 20 procedures in order to be proficient. A simpler method of NSV, called percutaneous vasectomy, is now being used. Recent research suggests that it works as well as standard NSV and is easier to perform. Percutaneous vasectomy uses the same instruments as no-scalpel vasectomy, but with a different surgical technique. The hemostat is used to first puncture the skin (instead of to spearing the vas and lifting it out). The ringed clamp is then passed through the incision and used to enclose the section of the vas that is then pulled out for closure. This avoids the need for the difficult wrist maneuver in NSV.

Percutaneous Vasectomy. Percutaneous vasectomy is an interesting approach that employs the same instruments as in no-scalpel vasectomy, but uses them in a different way that might avoid some of the learning problems. The hemostat is used to first puncture the skin (instead of to spearing the vas and lifting it out). The ringed clamp is then passed through the incision and used to enclose the section of the vas that is then pulled out for closure. This avoids the need for the difficult wrist maneuver in NSV.

Other Vasectomy Variations

Vasclip. The Vasclip is a new alternative to standard vasectomy and has received FDA clearance. This very small rice-sized plastic clip locks around the vas deferens and stops the flow of sperm. One small study reported fewer complications than with standard vasectomy, including infection and swelling. It may be more easily reversible than a standard vasectomy.