NSV - The Book - 002

No-Scalpel / No-Needle Vasectomy
How it’s done here…..

The No-needle injector delivers a fine jet of Xylocaine right through the scrotal skin onto the vas and surrounding tissue. It requires only 1/10th the volume of anesthetic compared with the needle method so there is less tissue distension and less risk of bleeding. Also it is a proven medical fact that men prefer to have needles kept as far from their scrotums as possible.

The "No-scalpel" part refers to the technique of getting to the vas at the front of the scrotum using two small surgical instruments developed in China in 1974. There are no knives, scalpels, lasers or other hi-tech gizmos involved. It is "minimally invasive" so there is less trauma to the tissues. The surgery and the recovery are usually fast and the pain is usually minimal.

First the right vas is held just under the skin , a tiny puncture is made and a small loop of the vas is lifted out. The particular method of blocking (occluding is the hi-tech term) varies from doctor to doctor.
I perform a modified open technique. The vas is cut leaving two ends. The end that carries sperm to the prostate where it mixes with the seminal fluid is cauterized and pinched, later to form a solid plug of scar tissue in the lumen of the vas. That end is further occluded by crimping a small titanium clip over it and its surrounding sheath. The end coming from the testicle is cauterized but otherwise left unblocked. The clip thus interposes tissue between the two ends so they heal in different tissue planes, reducing further the risk of sperm recannalizing a micro-channel through the roadblocks we've (well me, really) set in their path. Since the human sperm is designed for tunneling as well as swimming, we cannot be too careful, hence the “double block.

After the vasectomy the testicles continue to produce immature sperm but the body's recycling team, in the form of white blood cells, migrate to the region, engulf and destroy the sperm and return the component molecules into general cellular building blocks via the lymphatic channels. By the way, the titanium clips pose no harm to health. They don't set off airport security systems and they don't interfere with MRI scans. After a few weeks you usually can't feel them even if you try.

Here’s the play by play of the procedure:

  1. You lie down on your back.
  2. The penis is encircled with an elastic band the other end of which is clipped to the bottom of your shirt. (No pulling on the shirt!)
  3. The scrotum is cleansed with a colorless antiseptic solution. (No more messy iodine!) Local anesthetic is administered via injector (No more needle!). It freezes the skin and each vas. All you feel is a quick “flick” against the skin.
  4. Once the freezing takes effect the first vas is isolated and grasped with a small ring clamp, holding it to the skin.
  5. A tiny puncture is made over the vas with a fine tipped surgical instrument, then stretched open about 2 mm. The vas is grasped through the opening and a small segment is pulled through the skin opening.
  6. The vas is cut and blocked as described above then returned to the scrotum. Through the same opening the other vas is lifted out and treated exactly the same.
  7. The small opening is sealed closed with Skin Adhesive (medical-grade “crazy glue” at twenty times the price).
  8. You are fitted with a gauze-filled soft-cupped athletic support and requested to “Get dressed and send in the next victim.”

TIME ELAPSED: 15 minutes
TOTAL APPOINTMENT TIME: 30 minutes