No-Scalpel Vasectomy: An Illustrated Guide for ... - EngenderHealth

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A case in the United States illustrates the need forhands-on training.A group of experienced vasectomistsattended a one-day group orientation on no-scalpelvasectomy that consisted of a lecture, observation ofthe procedure, and limited practice with a scrotalmodel.They then received the special no-scalpelinstruments and returned to their practices to beginusing the technique.Three months later, anEngenderHealth trainer evaluated the physicians’operating performance.The doctors understood andperformed key elements of the procedure adequately;they stated that they had mastered about 80% of thetechnique without hands-on instruction.Yet theprocedures observed by the trainer still resulted in toomuch bleeding; benefits of the no-scalpel techniquewere therefore diminished. Consequently, theEngenderHealth trainer provided hands-on training tohelp the surgeons fully master the no-scalpel technique.No-scalpel vasectomy was developed and firstperformed in China in 1974 by Dr. Li Shunqiang ofthe Chongqing Family Planning Scientific ResearchInstitute, located in Sichuan Province.At that time,vasectomy was unpopular with Chinese men, andtubal occlusion was the predominant method ofvoluntary sterilization.Today in Sichuan, vasectomyoutnumbers tubal occlusion by a ratio of four to one;in the rest of China, tubal occlusion outnumbersvasectomy by five to one. More than 10 million Chinesemen have already undergone no-scalpel vasectomy.Historyof No-ScalpelVasectomyUnder the sponsorship of EngenderHealth, an internationalteam of experts visited Dr. Li Shunqiang in1985 and observed his refined vasectomy technique.They were convinced that the technique shouldbecome the standard approach for vasectomy. One ofthe team members, Dr. Phaitun Gojaseni, introducedthe no-scalpel technique in Thailand upon his return,while another member of the team, Dr. Marc Goldstein,performed the first no-scalpel vasectomy in the UnitedStates.Based upon the findings of the international team,EngenderHealth recommended that training in theno-scalpel approach to the vas should be providedto doctors in other countries and that this would befacilitated if the instruction could take place outside ofChina. EngenderHealth’s initial work in no-scalpel2 No-Scalpel Vasectomy: Illustrated Guide EngenderHealth
vasectomy focused on experienced vasectomists inlarge ongoing vasectomy services (Huber, 1989). In1986, Dr. Li Shunqiang and Dr. Goldstein traveled toBangkok to work with experienced vasectomists fromBangladesh, Nepal, Sri Lanka, and Thailand. Dr. ApichartNirapathpongporn of Thailand was trained at this time.Dr. Goldstein and Dr. Apichart then trained othersurgeons in their home countries. Clinical training thenexpanded to other countries. In several countries inAfrica, where vasectomy is just being introduced,doctors who have never performed vasectomy are nowbeing trained only in the no-scalpel technique.ClinicalFindingsNo-scalpel vasectomy results in fewer hematomas andinfections than does conventional incisional vasectomy(Table 1).TABLE 1. Percentage of vasectomies in which infection or hematoma or bleedingoccurred, by type of vasectomy and studyStudy No. of % with % withvasectomies infections hematomaor bleedingIncisional vasectomyPhilp, Guillebaud, & Budd, 1984 534 1.3 4.5Kendrick et al., 1987 65,155 3.5 2.0Nirapathpongporn, Huber, & 523 1.3 1.7Krieger, 1990Alderman, 1991 1,224 4.0 0.3Sokal et al., 1999 627 1.3 10.7No-scalpel vasectomyNirapathpongporn, Huber, & 680 0.2 0.3Krieger, 1990Li et al., 1991 179,741 0.9 0.1Li et al., 1991 238 0.0 0.0Viladoms Fuster & Shihua Li, 1994 400 0.0 0.0Arellano Lara et al., 1997 1,000 0.0 2.1Kumar et al., 1999 4,253 0.047 0.07Sokal et al., 1999 606 0.2 1.7Source: Adapted from Pollack & Barone, 2000.EngenderHealth Introduction 3
Page 1 and 2: NO-SCALPELVASECTOMYAn Illustrated G
Page 3 and 4: ContentsPreface to the Third Editio
Page 5 and 6: Figures1 Ringed clamp 72 Dissecting
Page 7 and 8: Preface tothe Third EditionVasectom
Page 9 and 10: AcknowledgmentsThe first edition of
Page 11: IntroductionThe purpose of this gui
Page 15 and 16: 1FacilitiesVasectomy can be perform
Page 17 and 18: 2Instrumentsand SuppliesThe no-scal
Page 19: TABLE 2. Instruments and supplies n
Page 22 and 23: Many of these conditions can be tre
Page 25 and 26: 4AnesthesiaGood local anesthetic te
Page 27 and 28: FIGURE 4.The three-finger technique
Page 29 and 30: FIGURE 6. Side view of the skin whe
Page 31 and 32: HINT: When the needle is in proper
Page 33 and 34: FIGURE 9.Anesthesia technique:Deep
Page 35 and 36: 5Surgical Approachand Occlusionof t
Page 37 and 38: eleasing it. Use the fingers of the
Page 39 and 40: ALTERNATIVE: Instead of the tight-s
Page 41 and 42: FIGURE 16. Piercing the skin with t
Page 43 and 44: FIGURE 17. Inserting both tips of t
Page 45 and 46: FIGURE 19. Piercing the wall of the
Page 47 and 48: dissecting forceps with the right h
Page 49 and 50: deliver the vas while the ringed cl
Page 51 and 52: Puncturingand Strippingthe SheathWi
Page 53 and 54: Occludingthe Right VasNow occlude t
Page 55 and 56: FIGURE 29. Steps in completing vase
Page 57 and 58: FIGURE 30. The completed fascial in
Page 59 and 60: FIGURE 33. Sometimes a segment ofth
Page 61 and 62: Applyingthe RingedClamp to theScrot
Page 63:
APPENDIXAND REFERENCES
Page 66 and 67:
Sterilization does not protect agai
Page 69 and 70:
ReferencesAlderman, P. M. 1991. Com
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