Vasectomy technique

Abstract

When performing a vasectomy, a gentle atraumatic technique reduces complications. The aim is to avoid cutting anything but the vas to reduce complications and to make microsurgical reversal possible. In this article common problems are discussed and possible solutions suggested. (An article 'Vasectomy in review' by the same author appears in the June issue.)

PIP: When performing vasectomies, surgeons should have 3 goals: 1) to reduce the failure rate due to spontaneous reanastomosis from current levels of 1 in 100 to 1 in 1000, 2) to prevent complications such as hematoma through the use of autramatic plastic surgical instruments, and 3) to maximize the potential for future microsurgical reversal. Achievement of these aims requires an understanding of the region, magnification for the identification of tissue layers, and sterile instruments. Although each vasectomist makes minor variations in technique, there are certain rules that should always be followed: do not use local anesthesia with adrenalin inside the scrotum, avoid testicle strangulation by not rotating the testicle 180 degrees out of normal alignment or operate on one side twice, do not use black braided silk sutures on Fallope rings inside the scrotum, use cremasteric fascial separation of the cut vas ends to prevent spontaneous reanastomosis, leave the testicular end open to the scrotum to reduce back pressure on the epididymis, use a water rather than spirit-based skin antiseptic, and adhere to all sterile procedures. The author outlines the steps involved in vasectomy, from preoperative assessment, skin preparation, anesthesia, isolation of the vas, incision, identification of the vas in the sheath, securing the cremasteric sheath, isolating only the vas, flushing the vas, severing the vas, cautery, open ended vasectomy, to skin closure. Also presented are guidelines for the postoperative period and the management of complications such as bleeding, hematomas, infection, adhesions, epididymitis and sperm granuloma, and neuritis.