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

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Men undergoing no-scalpel vasectomy reported lesspain during the procedure and early in the follow-upperiod than did men having an incisional vasectomy,and also reported earlier resumption of sexual activityafter surgery (Skriver, Skovsgaard, & Miskowiak, 1997;Sokal et al., 1999).Neither conventional nor no-scalpel vasectomy is timeconsuming.However, there are reports of decreasedoperating time when skilled providers use the noscalpelapproach (Li et al., 1991; Nirapathpongporn,Huber, & Krieger, 1990). For example, in the UnitedStates, a 40% reduction in operating time has beenreported with no-scalpel vasectomy (Li et al., 1991).4 No-Scalpel Vasectomy: Illustrated Guide EngenderHealth
1FacilitiesVasectomy can be performed in almost any facility(WHO, 1988).There are a few minimum requirementsto providing high-quality services:• A waiting area with a toilet (The waiting areamay also serve as a recovery area.)• A private space for counseling• An examination room for the preoperativeassessment and follow-up examination• A clean room for surgery, equipped with acomfortable, clean table for the client and agood light sourceIn most countries, no-scalpel vasectomy, likeconventional vasectomy, is an outpatient procedureperformed in an office or clinic.Warm RoomTemperatureNeeded to Relaxthe ScrotumThe temperature of the room is critical because itaffects the cremasteric and the dartos muscles. Theroom must be warm, even though a coolertemperature may be more comfortable for thephysician.By relaxing the scrotum, a warm room facilitates thefollowing:• Manipulation of the vas by using the threefingertechnique (see pages 17 and 21 to 22 fora description)• Fixation of the vas under the median raphe ofthe scrotum• Isolation of the vas from the relaxed spermaticcord• Reduction of operating time• Reduction of complicationsEngenderHealth 5
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 and 12: IntroductionThe purpose of this gui
Page 13: vasectomy focused on experienced va
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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No-Scalpel Vasectomy: An Illustrated Guide for ... - EngenderHealth

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