Optimizing the Modified No-Scalpel Vasectomy Technique

Summary

A modified no-scalpel vasectomy technique reduces the postoperative recanalization rate. This protocol describes a modified no-scalpel vasectomy technique that can reduce the postoperative recanalization rate.

Abstract

No-scalpel vasectomy (NSV) is a commonly used contraceptive method for males. In previous applications of this surgical method, issues such as knot detachment and postoperative recanalization resulted in a reduced contraceptive success rate after vasectomy. This new technique innovatively modifies the ligation procedure during NSV to address knot detachment and postoperative recanalization. Two ligations of the testicular end of the vas deferens and one ligation of the abdominal end are completed before transection of the vas deferens. A fourth ligation of the abdominal end is performed using the suture tails of the third ligature of the testicular end after transection of the vas deferens. The fifth ligation of the abdominal end is performed using the suture tails of the first ligature of the testicular end. These modifications strengthen the ligations and reduce the postoperative recanalization rate. Additionally, the two stumps are gathered together, creating better conditions for a possible vasovasostomy in the future, thereby achieving overall better outcomes with vasectomy.

Introduction

Vasectomy is a surgical sterilization procedure for men to prevent future fertility^1,2,3. It is equally effective as tubal ligation for preventing pregnancy but is simpler, safer, faster, and less expensive⁴. This type of surgery has lower implementation requirements, and more than 80% of vasectomies are performed in the office⁵. Since 1971, when Li Shunqiang et al. performed the first modified vasectomy (the no-scalpel vasectomy or NSV)⁶, the procedure has advanced significantly. The invention of the ext....

Protocol

The surgical method described in this paper has been approved by the Ethics Committee of the West China Second University Hospital of Sichuan University, and the use of patient surgical videos has been authorized. Informed consent was obtained from the patients, and their data was used for presentation. The consumables and equipment used for this study are listed in the Table of Materials.

1. Preparation for operation

1. Use the following inclusion cr.......

Discussion

The gold standard for vasectomy is ligation with mucosal cautery¹³, but not all operating rooms have electrocautery equipment. Therefore, this modification technique achieved ideal surgical results by ligating the vas deferens five times with non-absorbable silk sutures, without the need for electrocautery equipment. It has been documented that applying excessive pressure to the vas with sutures can create ischemia and sloughing of the ligated stump, leading to recanalization. This may explain som.......

Materials

Name	Company	Catalog Number	Comments
3-0 silk braided non-absorbable suture	Johnson & Johnson Medical (China) Ltd.	SA84G	15 × 60cm
5-0 Coated VICRYL Plus (Polyglactin 910) Synthetic Absorbable Suture	Ethicon.Inc.	VCP433H	13 mm 1/2c (70cm)
Dissecting clamp	Xinhua Surgical Instruments Co., Ltd.	ZJ197R	125 mm
Extracutaneous vas deferens fixation ring clamp	Xinhua Surgical Instruments Co., Ltd.	ZJ196R	140 mm
Scissors	Xinhua Surgical Instruments Co., Ltd.	ZC344R	140 mm
SPSS 23.0	IBM