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

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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
FIGURE 16. Piercing the skin with the medial bladeof the dissecting forcepsLeft handScrotalskinVaslumenVasPITFALLS: Avoid three pitfalls when puncturingthe scrotal skin. First, be sure to penetrate theanterior wall of the vas with the dissectingforceps. Otherwise, intact overlying fascia willprevent elevation of the vas out of the puncturewound. Second, if puncturing is too deep,transection of the vas might occur and the vasartery may be damaged, and bleeding willfollow. Third, be sure to puncture the vas justsuperior to the upper edge of the ringedforceps; if the puncture is made in the tissuethat is grasped by the ringed forceps, you willnot be able to spread the tissues adequately(see next page).EngenderHealth Surgical Approach and Occlusion of the Vasa 31
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 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: ALTERNATIVE: Instead of the tight-s
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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