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

FIGURE 15. Pressing the index finger lightlydownward to tighten the scrotalskin just ahead of the tips ofthe ringed clamp and overthe anesthetized areaLeft handHold the dissecting forceps in the right hand, pointscurved downward, in preparation for puncturing thevas. Hold the instrument so that there is a 45-degreeangle between the closed tips of the forceps and thelumen. Then open the forceps; using only the medialblade (see box on page 32) of the forceps, pierce thescrotal skin just superior to the upper edge of theringed forceps—where the vas is most prominent(Fig. 16). This piercing should result in a puncture ofthe midline of the vas, preferably at the point wherethe needle entered for anesthetic infiltration. Whenmaking the puncture, do not slowly push thedissecting forceps forward. Instead, use a quick, sharp,single movement to make a clear puncture of the skindown into the vas. Advance the medial blade of theforceps into the vas lumen.30 No-Scalpel Vasectomy: Illustrated Guide EngenderHealth