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. 2014 Mar 30;2014(3):CD004112.
doi: 10.1002/14651858.CD004112.pub4.

Scalpel versus no-scalpel incision for vasectomy

Lynley A Cook  1 , Asha Pun, Maria F Gallo, Laureen M Lopez, Huib A A M Van Vliet
Affiliations

Scalpel versus no-scalpel incision for vasectomy

Lynley A Cook et al. Cochrane Database Syst Rev. .

Abstract

Background: Currently, the two most common surgical techniques for approaching the vas during vasectomy are the incisional method and the no-scalpel technique. Whereas the conventional incisional technique involves the use of a scalpel to make one or two incisions, the no-scalpel technique uses a sharp-pointed, forceps-like instrument to puncture the skin. The no-scalpel technique aims to reduce adverse events, especially bleeding, bruising, hematoma, infection and pain and to shorten the operating time.

Objectives: The objective of this review was to compare the effectiveness, safety, and acceptability of the incisional versus no-scalpel approach to the vas.

Search methods: In February 2014, we searched the computerized databases of CENTRAL, MEDLINE, POPLINE and LILACS. We looked for recent clinical trials in ClinicalTrials.gov and the International Clinical Trials Registry Platform. Previous searches also included in EMBASE. For the initial review, we searched the reference lists of relevant articles and book chapters.

Selection criteria: Randomized controlled trials and controlled clinical trials were included in this review. No language restrictions were placed on the reporting of the trials.

Data collection and analysis: We assessed all titles and abstracts located in the literature searches and two authors independently extracted data from the articles identified for inclusion. Outcome measures included safety, acceptability, operating time, contraceptive efficacy, and discontinuation. We calculated Peto odds ratios (OR) with 95% confidence intervals (CI) for the dichotomous variables.

Main results: Two randomized controlled trials evaluated the no-scalpel technique and differed in their findings. The larger trial demonstrated less perioperative bleeding (OR 0.49; 95% CI 0.27 to 0.89) and pain during surgery (OR 0.75; 95% CI 0.61 to 0.93), scrotal pain (OR 0.63; 95% 0.50 to 0.80), and incisional infection (OR 0.21; 95% CI 0.06 to 0.78) during follow up than the standard incisional group. Both studies found less hematoma with the no-scalpel technique (OR 0.23; 95% CI 0.15 to 0.36). Operations using the no-scalpel approach were faster and had a quicker resumption of sexual activity. The smaller study did not find these differences; however, the study could have failed to detect differences due to a small sample size as well as a high loss to follow up. Neither trial found differences in vasectomy effectiveness between the two approaches to the vas.

Authors' conclusions: The no-scalpel approach to the vas resulted in less bleeding, hematoma, infection, and pain as well as a shorter operation time than the traditional incision technique. No difference in effectiveness was found between the two approaches.

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Conflict of interest statement

L Lopez is employed at FHI 360 (formerly known as Family Health International) where one of the included trials was conducted (Sokal 1999). She was not involved in that trial.

Figures

1.1
1.1. Analysis
Comparison 1 No‐scalpel versus standard incision, Outcome 1 Perioperative bleeding.
1.2
1.2. Analysis
Comparison 1 No‐scalpel versus standard incision, Outcome 2 Hematoma during follow up.
1.3
1.3. Analysis
Comparison 1 No‐scalpel versus standard incision, Outcome 3 Operating time <=6 minutes.
1.4
1.4. Analysis
Comparison 1 No‐scalpel versus standard incision, Outcome 4 Operating time >=11 min.
1.5
1.5. Analysis
Comparison 1 No‐scalpel versus standard incision, Outcome 5 Perioperative difficulty in identifying ductus.
1.6
1.6. Analysis
Comparison 1 No‐scalpel versus standard incision, Outcome 6 Perioperative difficulty in isolating the vas.
1.7
1.7. Analysis
Comparison 1 No‐scalpel versus standard incision, Outcome 7 Perioperative equipment difficulties (unspecified).
1.8
1.8. Analysis
Comparison 1 No‐scalpel versus standard incision, Outcome 8 Perioperative need for assistance from second operator.
1.9
1.9. Analysis
Comparison 1 No‐scalpel versus standard incision, Outcome 9 Perioperative pain.
1.10
1.10. Analysis
Comparison 1 No‐scalpel versus standard incision, Outcome 10 Pain during follow up.
1.11
1.11. Analysis
Comparison 1 No‐scalpel versus standard incision, Outcome 11 Pain or tenderness during long‐term follow up.
1.12
1.12. Analysis
Comparison 1 No‐scalpel versus standard incision, Outcome 12 Scrotal pain during follow up.
1.13
1.13. Analysis
Comparison 1 No‐scalpel versus standard incision, Outcome 13 Pain at ejaculation during follow up.
1.14
1.14. Analysis
Comparison 1 No‐scalpel versus standard incision, Outcome 14 Infection during follow up.
1.15
1.15. Analysis
Comparison 1 No‐scalpel versus standard incision, Outcome 15 Wound problems during follow up.
1.16
1.16. Analysis
Comparison 1 No‐scalpel versus standard incision, Outcome 16 Sterility.
1.17
1.17. Analysis
Comparison 1 No‐scalpel versus standard incision, Outcome 17 Vasectomy failure.
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References

References to studies included in this review

Christensen 2002 {published data only}
    1. Christensen P, Al‐Aqidi OA, Jensen FS, Dorflinger T. Vasectomy. A prospective, randomized trial of vasectomy with bilateral incision versus the Li vasectomy [Vasektomi. Et prospektivt, randomiseret studie af vasektomi med dobbeltsidig incision vs. vasektomi a.m. Li]. Ugeskr Laeger 2002;164:2390‐4. - PubMed
Sokal 1999 {published data only}
    1. Sokal D, McMullen S, Gates D, Dominik R. A comparative study of the no scalpel and standard incision approaches to vasectomy in 5 countries. The Male Sterilization Investigator Team. Journal of Urology 1999;162:1621‐5. - PubMed

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