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

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FIGURE 2.Dissecting forceps2. The dissecting forceps (Fig. 2) is similar to acurved mosquito hemostat, except that the tips aresharply pointed. It is used to puncture the scrotal skin,to spread the tissues, to dissect the sheath, and todeliver the vas deferens. The dissecting forceps can alsobe used to grasp the vas while a ligature or cautery isapplied for occlusion. Because the instrument is amodified hemostat, it can be used to control bleeding.Throughout this manual, the term dissecting forcepswill be used to refer to this instrument.Additional instruments and supplies needed for noscalpelvasectomy are:• A 10-cc syringe with a 1 1 ⁄2-inch, 25- or 27-gauge needle (U.S. system). The syringe andneedle are used to infiltrate the local anesthetic,both for the skin wheal and the vasal blockanesthesia (see Chapter 4).• Straight scissors, to cut the vasa deferentia andligatures.• Supplies for vasal occlusion (for example,ligature material or a cautery unit).Table 2 presents a complete list of instruments andsupplies needed for no-scalpel vasectomy.8 No-Scalpel Vasectomy: Illustrated Guide EngenderHealth
TABLE 2. Instruments and supplies neededfor no-scalpel vasectomyInstruments• Ringed clamp• Dissecting forceps• Straight scissorsSupplies• Adhesive tape and gauze for positioning the penisaway from the surgical field (optional)• Scissors for clipping any scrotal hair that wouldinterfere with the procedure• Soap and water or antiseptic agents for thesurgical scrub (see page 13)• Alcohol rinse (recommended if plain soap is usedfor the surgical scrub)• Sterile gloves• Nonirritating antiseptic solution for cleaning theoperative area (see page 12)• Sterile drapes• 10-cc syringe with a 1 1 ⁄2-inch, 25- or 27-gaugeneedle (U.S. system)• 1% or 2% lidocaine without epinephrine a• Supplies for vasal occlusion according to thesurgeon’s preference (examples: a cautery unit;chromic catgut or nonabsorbable silk or cotton forligation)• Sterile gauze• Adhesive tape or Band-Aid for dressing the wound• Scrotal support for the man to wear after theprocedure (optional)a Synonyms and proprietary names for generic terms used in this bookare given below. Proprietary names are in brackets:lidocaine = lignocaine = [Xylocaine]epinephrine = adrenalineEngenderHealth Instruments and Supplies 9
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 and 14: vasectomy focused on experienced va
Page 15 and 16: 1FacilitiesVasectomy can be perform
Page 17: 2Instrumentsand SuppliesThe no-scal
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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