Vasectomy — No Scalpel Open-Ended Technique

What is a vasectomy?

A vasectomy is a minor surgical procedure to cut and tie off the vasa deferens, which are the small tubes that carry sperm from the testes to the prostate. These can be accessed easily via small (3mm) incisions in the scrotum. This may be done under either local or general anaesthesia.

Who is suitable for a vasectomy?

A vasectomy has to be considered an irreversible procedure. It is preferable that you are in a long term relationship and are sure that you have completed your family.

What is the No Scalpel technique?

During a standard vasectomy, two incisions are made in the scrotum to allow the surgeon to reach each of the man’s vas deferens.

During a no-scalpel vasectomy, no incisions are made. Instead, the surgeon uses a hemostat (locking forceps with a sharp tip) to puncture through the skin of the scrotal sac. Then, the skin is gently spread only until both vas deferens can be visualized. Because the puncture site is so small and is just through the skin, stitches are usually not required and healing time is quick. As compared to a traditional vasectomy, the no-scalpel approach is a less invasive and quicker procedure.

How is the No Scalpel vasectomy done?

The goal during a no-scalpel vasectomy is the same as for a conventional vasectomy – to create a blockage in the vas deferens, so that sperm can no longer become part of the semen. This is done by cutting off a short piece of the vas deferens, removing it, and then ligating (tying-off), clipping or cauterizing (burning) the remaining vas ends.

An additional step of fascial interposition which consists of sewing connective tissue over the free prostatic end of vas (the end closest to the urethra) is also done. This creates a tissue barrier between the cut ends of the vas deferens. Some research suggests that this additional step decreases failure rates.

What about the “open ended” technique?

Men may be given the choice to have an “open-ended” procedure. This means that only the prostatic end of vas is tied or cauterized. The testicular end (closest to the testis) is left open. The reason for keeping this end open is to allow for sperm leakage.

Some research has shown that allowing for this leakage prevents the thickening or build-up of sperm because the sperm can flow into and be absorbed by the scrotum. This, in turn, can lead to less pressure -- the potential cause of chronic post-vasectomy pain.

The open-ended technique has also been shown to lower complication rates as well as fewer cases of epididymitis (when the epididymis tube at the back of the testicle responsible for storing and carrying sperm becomes inflamed).

Potential Side Effects

Typically, a no-scalpel vasectomy does not have any major side effects and is only linked to a very small chance of infection and little pain. You may experience a reaction to the local anesthesia. Some men report short-term tenderness and a little bit of bruising after the procedure.

There is a tiny chance of developing sperm granuloma – a hard, sometimes painful pea-sized lump due to the sperm leaking out from the open-ended vas deferens. The lump is not dangerous, rarely symptomatic and is almost always resolved by the body in time. Plus, it may actually serve a protective feature to the testis and epididymis. The granuloma is rich in epithelial-lined channels that may vent leaking sperm away from the epididymis and protect against increased pressure from sperm blockage.

Am I sterile immediately after my vasectomy?

No, it takes time for the active sperm in your system to clear before you are sterile. This generally takes around 20 ejaculations or 2 months. It is mandatory that you give a semen sample for analysis after 8-12 weeks to ensure you have no sperm in your ejaculate (azoospermia). Until this point, you and your partner should use an alternative method of contraception.

Can we have an unwanted pregnancy even if my semen analysis is clear?

Yes, but this is exceedingly rare. No form of contraception is 100% reliable. It is possible for the vas to rejoin over time, but this occurs in less than 0.1% of patients who have the procedure. Overall, vasectomy is much more effective than condoms, the oral contraceptive pill or tubal ligation.

Can my vasectomy be reversed?

A vasectomy reversal may be performed in many cases, but it does not always work. Therefore having a vasectomy has to be considered irreversible. The older your partner and the longer time from your vasectomy result in poorer outcomes for reversal.

What is post-vasectomy pain syndrome?

Post-vasectomy pain syndrome (PVPS) may occurs in 5% of men after a vasectomy. It may cause aching, discomfort and sometimes more severe pain in the scrotum, even many years after the procedure.

In most cases, this is only a mild discomfort and is well tolerated. In a small number of men, the pain can be quite debilitating and require intervention. Research suggests that the open ended technique may reduce the risk of chronic post vasectomy pain syndrome.