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

ALTERNATIVE: Instead of the tight-skin techniquedescribed on page 26, some surgeons apply the ringedclamp in a different way when they are first learning noscalpelvasectomy. With the ringed clamp in the right hand,the surgeon gently pinches the scrotal skin with the ringedclamp, intentionally encircling more skin than is graspedwith the tight-skin technique. With the left hand, thesurgeon then eases out excess tissue from the tips of theringed clamp. The surgeon may wish to use this alternativeif he or she is having difficulty isolating only the vas.Elevatingthe UnderlyingRight VasWhile the ringed clamp is still grasping the scrotalskin and the underlying right vas, transfer theinstrument to your left hand. Then lower the handlesof the ringed clamp, causing a bend in the vas (Fig.14). This motion elevates the vas. Continue to keepthe shaft of the clamp in line with the longitudinalaxis of the vas.Puncturing theScrotal SkinThe skin should be punctured in the previouslyanesthetized spot, midway between the top of the testesand the base of the penis (Fig. 4, page 17).With the leftindex finger, press downward lightly to tighten thescrotal skin just ahead of the tips of the ringed clampand over the anesthetized area (Fig. 15, page 30).FIGURE 14. Lowering the handles of the ringed clampto elevate the vasEngenderHealth Surgical Approach and Occlusion of the Vasa 29