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

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PITFALLS: Watch out for three pitfalls whengrasping the vas with the ringed clamp. First,be careful not to release the dissecting forcepsuntil you have grasped a portion of the loop ofthe vas with the ringed clamp (Fig. 23). Thiswill prevent the vas from slipping back into thescrotum. Second, to avoid damaging the vasartery, be sure to grasp the vas at the crest ofthe loop (Fig. 24). Grasping elsewhere leads toasymmetrical stripping of the sheath from thevas. Third, grasp only a partial thickness of thevas. If the ringed clamp is placed around theentire circumference of the vas, the vas couldslip back into the scrotum when it is divided.FIGURE 24. Grasping a partial thickness ofthe elevated vas at the crest ofthe loop, with only the ringedclamp attached40 No-Scalpel Vasectomy: Illustrated Guide EngenderHealth
Puncturingand Strippingthe SheathWith one tip of the dissecting forceps (tips facingup), gently puncture the vas sheath just below thevas, taking care not to injure the vas artery (Fig. 25).Then remove the tip.Close the tips of the dissecting forceps. Insert bothtips (tips facing to the side) into the punctured sheath(Fig. 26, page 42).Gently open the dissecting forceps (Fig. 27, page 42).Strip the sheath and surrounding tissues downward forat least a 1 cm length of vas. This is a longitudinal, nota transverse, motion.Be careful to avoid blood vessels. Clamp or cauterizebleeders immediately. When checking for bleeding,pay particular attention to the abdominal segment ofthe vas, which is where bleeding from the vas arterycould occur (a common reason for hematomaformation).FIGURE 25. Puncturing the sheath with one tip of thedissecting forcepsABVasVasarteryEngenderHealth Surgical Approach and Occlusion of the Vasa 41
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 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: deliver the vas while the ringed cl
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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