Vasectomy is a worthwhile procedure that is best performed in a family doctor’s office. No-scalpel vasectomy is a refined form of the procedure that has gained more patient acceptance and popularity.
In order for family doctors and other people with general surgical experience to become more skilled in their application, this learning package will present information about the function of vasectomy and specifics of the no-scalpel technique. We strongly advise that before putting these techniques into practice, the learner receive hands-on instruction in a real surgical setting, accompanied by a preceptor who is knowledgeable about no-scalpel vasectomy technique. The effort and expense are well worth the education that can only be obtained in this way in some cases.
Optimising provider abilities through advanced training and practice will ensure the best results of vasectomy and thereby promote wider acceptance of this beneficial procedure in the community.
What is No Scalpel Vasectomy?
In order to deliver the vas with the least amount of trauma, the NSV procedure follows a carefully planned out series of precise steps . The process is completed by presenting the bare vas for occlusion, but it makes no demands regarding how it should be done.
The perivasal block was a novel and successful approach to vas anaesthesia introduced by NSV. One of the typical challenges faced when beginning a vasectomy is overcome by the three-finger fixation of the vas. It is possible to securely grasp the vas before puncturing the skin by using the vas-fixing forceps to steady the vas through the skin.
When done carefully, the puncture separates all of the fascia layers around the vas, exposing it. This non-traumatic technique safely separates the numerous blood vessels that make up the fascia. so that there is absolutely no bleeding.
A unique movement is used in the hook and delivery. It requires bravery to let go of the forceps’ firm hold on the vas and have faith that it will slide free of its sheath so that it can be re-grasped without disappearing from view.
After carefully separating the fascia from the exposed vas, an avascular segment is presented for occlusion using the sharp dissecting forceps.
Advantages and Disadvantages of No Scalpel Vasectomy
Compared to the conventional incisional vasectomy, the NSV has a number of benefits. There may be less discomfort during and following the procedure if the perivasal anaesthetic is effective and the tissues are handled less harshly.
There is little to no bleeding, which reduces the possibility of postoperative hematoma or infection. The procedure can be completed fairly quickly thanks to effective vas delivery and dissection, and successful vas occlusion is made possible by the excellent vas exposure. Recovery typically goes smoothly because there is little tissue trauma.
The requirement for specialized instruments and specialized surgical abilities are potential obstacles to NSV. Obviously, benefits increase as experience increases. After performing 10 to 15 procedures, the majority of doctors will feel at ease using NSV, and after about 30 NSV procedures, they are likely to be unwilling to use the incisional technique again.
Surgical Setup and NSV Instruments
Like other minor office procedures, a vasectomy can be carried out in a procedure room or exam room that has enough room for the patient and his partner and allows the doctor and any other staff to move around without difficulty. The space should be spotless, well-lit, and equipped with all necessary materials. Any requirements the surgeon, the patient, or the patient’s partner may have should be handled by an assistant who should be nearby.
For this procedure, a regular exam table is acceptable as long as it is set at the surgeon’s preferred working height. The occasional patient who experiences syncope or light-headedness due to vasovagal reaction might benefit from a power table with an optional Trendelenburg position. Excellent lighting is crucial. The ideal surgical lamp is a high-intensity halogen lamp. It is not ideal to have a typical gooseneck lamp with a standard bulb.
For fascial interposition, you can use either 4-0 chromic gut suture or another absorbable suture material. Some surgeons favour the use of metallic fascia clips. However, a sterile applicator instrument needs to be kept on hand. Clips can help prevent fascial tissue bleeding from the use of the suture needle. The suture might also aid in hemostasis more effectively.
In NSV, two unique instruments are utilised. The first is a locking clamp that closes to create a ring around the vas, the vas-fixing forceps. The blunt tips approximate with just enough pressure to prevent the vas from slipping out of the ring but without injuring the surrounding skin and tissues. This clamp re-grasps the exposed loop of vas after delivery of the vas between its blunt tips. Vas-fixing forceps come in two different designs. The Chinese style was created by Dr. Li specifically for the NSV and features a smaller ring (available in three diameters: 3.0, 3.5, or 4.0mm) that limits the grasping volume and a cantilever design that reduces the pressure applied to the closed tips.
The U.S. style has a closer grip due to its shorter hinge-to-tip distance, which was originally designed by Dr. Wilson as a help for incisional vasectomy. The Wilson clamp’s ring volume also makes it possible to grasp denser scrotal tissues that surround the vas. One of each type of vas-fixing forceps may be useful to have on the NSV tray.
The pointed dissecting forceps are the second tool. This curved clamp has sharp tips that precisely meet each other, resembling a mosquito hemostat. It is used to pierce the skin and fascia, spread the tissue layers, deftly push aside blood vessels, hook and extract the vas from its sheath, and puncture the skin and fascia. Although a hemostat might be preferable due to the sharpness of the tips, this clamp may be used to grasp tissues. The sharp dissecting forceps must be handled carefully to prevent injury to the staff handling and cleaning them as well as to the tips from deterioration.
The no-scalpel vasectomy procedure offers a highly effective and minimally invasive option for male sterilization. By eliminating the need for surgical incisions and sutures, it significantly reduces the associated risks, discomfort, and recovery time. This innovative technique utilizes specialized instruments to access and seal the vas deferens, ensuring a reliable method of contraception with a lower incidence of complications. With its numerous advantages, including reduced pain, faster healing, and improved patient satisfaction, the no-scalpel vasectomy has become a preferred choice for individuals seeking a safe and convenient form of permanent birth control.