Male sterility – this procedure does not confer 100% sterility even when properly done by experienced surgeons.
Generally men who are unmarried, have no children, or have no other clear indication for the procedure should be counseled as to the appropriateness of the procedure.
Surgical Details of the Vasectomy Procedure
The traditional approach in vasectomy was to ligate each vas deferens through lateral incisions on the scrotum. The no-scalpel technique was introduced into the United States in 1986 and has been modified by many practitioners. Described below is one commonly used procedure performed by experienced urologists.
1. The scrotum is shaved using an electric razor.
2. The shaft of the penis is retracted toward the abdomen.
3. A three finger technique is used to first palpate and then using the middle finger to manipulate the right vas deferens to the skin level of the median raphe of the scrotum.
4. The middle finger is then used to “piano wire” the vas deferens and the thumb and index finger are used to stretch the skin over the vas. Plain lidocaine (1% – 2% without epinephrine) is then injected into the median raphe transversely until a skin wheal is raised that is 1cm – 2cm in diameter.
5. Once the skin wheal has been raised a few second are allowed to elapse while the anesthetic effect begins.
6. A scalpel is used to make a 1.0 cm incision transversely over the vas deferens until the vasal sheath is appreciated.
7. The vas sheath is then opened longitudinally with the scalpel, thus exposing the vas.
8. The vas is grasped with a Allis clamp or Adison forceps with care taken to avoid grasping the sheath.
9. The vas should be easily removed from its incised sheath anteriorly and a fine-tipped mosquito clamp is used to dissect the vas away from the posterior sheath and the vascular structures.
10. A 1.5 to 2.0 cm bare segment of vas should be exposed with a 2-0 Vicryl or silk suture placed on the testicular margin of the dissected vas.
11. The vas is then transected with a scalpel or scissors.
12. The abdominal margin of the vas should have a readily visualized lumen which can be irrigated to remove any residual sperm.
13. A hot-wire is then placed .5 cm into the open lumen of the vas and slowly withdrawn as the current is applied, with the goal to cause sufficient necrosis to cause fibrosis of the lumen without causing a full-thickness burn which will promote recanalization.
14. The vas is then released and allowed to retract into the vas sheath.
15. The sheath is then sewn over the now-occluded lumen using an interrupted 3-0 Chromic suture.
16. A segment of the testicular margin of the vas is removed to insure there is at least a 1 cm gap between the cut ends.
17. The other vas deferens is then manipulated to the center incision and the above procedure is repeated.
18. When both vas structures have been ligated, the wound is inspected for hemostasis.
19. To begin closure in the vasectomy procedure the skin is reapproximated using an interrupted 3-0 Chromic suture.
20. Antibiotic ointment is applied to the skin and the vasectomy incision is covered with gauze and held in place with scrotal support.