Surgery
Vasectomy is a minor operation that takes about 30 minutes and is usually performed in a doctor's office or a family planning clinic. If the operation is performed under local anesthesia, the cost ranges from about $500 to $1000. Most insurance policies will cover vasectomies performed as a minor outpatient procedure, but will not cover vasectomies performed as major surgery in an operating room. If a Vasclip procedure is performed, there may be an additional cost of $400 to $500 for this device.
The Procedure.
- To prevent increased risk of bleeding, patients should avoid taking aspirin or NSAIDs (Advil, Motrin) for 10 days prior to the procedure.
- Before the operation, the patient's scrotum is shaved and cleaned.
- A local anesthetic is injected into the scrotum. Patients should ask their physician about applying an anesthetic cream (e.g., EMLA) before the injection to reduce its pain.
- The surgeon makes a tiny incision on one side of the scrotum and locates one vas deferens. The vas deferens is isolated, drawn through the incision, and clamped at two sites close to each other.
- The segment between the clamps (which should be more than 15 mm, or a little over half an inch) is then removed.
- The surgeon then seals off (ligates) the tube with surgical clips, sutures, cauterization using an electric needle, or some combination. Fascial interposition is an additional technique that may be used in combination with these methods (usually with cauterization) to enhance closure. With this process, after the vas is cut, the surgeon pulls the fibrous layer covering the vas (the fascia) over the severed end of the vas and sews it closed. This increases the barrier and further reduces residual sperm. It may be beneficial only for younger men, however.
- Investigators are testing chemicals to irrigate the vas after it has been cut to flush out residual sperm. Chemicals showing promise include diltiazem (a drug known as a calcium channel blocker) and methylene blue (a commonly used dye).
- The surgeon may choose to close off either one end of the vas (called an open-ended procedure) or both ends (closed-ended technique). In the open-ended procedure, the vas section connected to the testis is left open and the one leading to the prostate is sealed; in the closed-ended approach both are sealed. Many surgeons now prefer the open-ended version because it is proving to have lower complication and failure rates than the closed-ended method, and it results in fewer cases of chronic pain.
- After closing off the tube, the vas deferens is gently placed back into the scrotum.
- The procedure is then repeated on the other side.
- After a short rest, usually about half an hour, the patient can leave the doctor's office or clinic. Arrangements should be made ahead of time for someone else to drive the patient home.
|
Click the icon to see an illustrated series detailing a vasectomy. |
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.
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 is just as effective as conventional vasectomy and takes less time. NSV is difficult to perform, however, and most surgeons must perform about 15 to 20 procedures in order to be proficient. Because of this steep learning curve, studies are mixed on whether it poses any fewer postoperative problems, including pain or infection, than the conventional surgery. Increasing surgical experience with this procedure may produce better results over time.
Other Vasectomy Variations
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.
Ultrasound. One investigative approach using ultrasound employs a tiny device built into the clamp that holds the vasa deferentia. The device emits ultrasound pulses for 20 to 50 seconds, which heats the cells and kills them. The dead cells plus the scar tissue that forms around them creates the obstruction that blocks the tube.
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.
|
