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

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© 2003 EngenderHealth. All rights reserved.440 Ninth Avenue, New York, NY 10001 U.S.A.Telephone: 212-561-8000Fax: 212-561-8067e-mail: info@engenderhealth.orgwww.engenderhealth.orgFirst edition printed 1992Second edition printed 1997This publication was made possible, in part, through supportprovided by the Office of Population, U.S. Agency forInternational Development (AID), under the terms ofcooperative agreement HRN-A-00-98-00042-00. The opinionsexpressed herein are those of the publisher and do notnecessarily reflect the views of AID.Figures 1, 4, 8, and 27 are adapted from: Li, S. Q., et al. 1991.The no-scalpel vasectomy. Journal of Urology 145(2):341–344.Used by permission.Figures 3, 6, and 7 are adapted from: Li, P. S., et al. 1992. Externalspermatic sheath injection for vasal nerve block. Urology39(2):173–176.The two figures that appear in the section “Alternative”on page 38 are based on drawings provided by Dr. ApichartNirapathpongporn. Used by permission.ISBN 1-885063-34-2Printing: Automated Graphic Systems, Inc.Printed in the United States of America. Printed on recycledpaper.Library of Congress Cataloging-in-Publications DataNo-scalpel vasectomy : a training curriculum for surgeons.--3rd ed.p. ; cm.Revisions for the third edition were made by Dr. Mark Barone et al.Includes bibliographical references.ISBN 1-885063-34-21.Vasectomy. I. Barone, Mark.[DNLM: 1.Vasectomy--methods. 2.Anesthesia--methods. 3. Preoperativecare--methods.WJ 780 N739 2002]RD585.5.N6 2002617.4’63--dc212002192868
ContentsPreface to the Third Edition . . . . . . . . . . . . . . viiAcknowledgments . . . . . . . . . . . . . . . . . . . . . ixIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . 1Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Warm room temperature neededto relax the scrotum 5Instruments and Supplies . . . . . . . . . . . . 7Preoperative Preparation . . . . . . . . . . . . 11Counseling and informed consent 11Preoperative history and examination 11Preparing the client for surgery 12Securing the penis 12Cleaning the operative area 12The surgical scrub 13Draping the operative field 13Optional: Administering a preoperativetranquilizer 13Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . 15Preparing for anesthesia;selecting the anesthetic and supplies 16The three-finger technique:Isolating the right vas 17Raising the skin wheal 18Creating the vasal block: Right vas 20The three-finger technique: Isolating the left vas 21Creating the vasal block: Left vas 23Pinching the skin wheal 24If the client feels pain after surgery begins… 24EngenderHealthiii
Page 1: NO-SCALPELVASECTOMYAn Illustrated G
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 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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