V3-07: No-Needle, No-Scalpel Vasectomy: Single Surgeon Experience
Vasectomy is a safe and effective method of permanent contraception for men and is the most commonly performed urologic procedure in North America. Since the no-scalpel vasectomy (NSV) was introduced to North America by Dr. Marc Goldstein in 1985, it has become the preferred minimally-invasive technique for vasectomy. However, the use of a needle to deliver local anesthetic during NSV and the fear of pain cause reluctance to proceed with NSV. In this video, we eliminate the use of a needle by using a MadaJet injector to deliver local anesthetic in a revision of the NSV technique – the no-needle NSV. We also utilize intraluminal thermal cautery, clip occlusion of the testicular end, fascial interposition and excision in an effort to minimize failure.
The patient is placed in the supine position and a single site in the upper-third of the scrotal median raphe is chosen. The right vas deferens is isolated from the spermatic cord and stabilized using the three-finger technique. A jet injector delivers three sprays of local anesthetic into the skin and vas deferens without leaving skin wheals or inducing local edema. The onset of anesthesia is almost immediate. The vas deferens is grasped by a NSV ringed forceps while a sharp NSV dissecting forceps is used to puncture the skin and vasal sheath to ultimately deliver the bare vas deferens. Next, the vas deferens is occluded using four techniques: intraluminal thermal cautery, clip occlusion of the testicular end to prevent sperm leakage, fascial interposition, and excision of a 1cm vasal segment. The vas deferens is then returned to the scrotum. The left vas deferens is anesthetized and delivered through the same puncture wound and occluded in the same way.
1,007 NSVs were performed by a single surgeon (MG), of which 485 were no-needle NSVs. Of those undergoing no-needle NSVs, only one case (0.2%) required redo vasectomy for persistent non-motile sperm on post-vasectomy semen analysis. There were three minor complications (0.6%) – two hematomas managed conservatively and one infection requiring drainage. No chronic post-vasectomy pain was reported.
The no-needle NSV using a MadaJet injector is a safe and effective modification of the NSV that provides excellent anesthesia. This technique may enhance patient satisfaction and reduce men’s fear of needles as an obstacle to vasectomy.
Funding: This project was supported by grant number T32HS00066 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. The project was also supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust.