No-Needle No-Scalpel Vasectomy: Procedures and Success Rate

I specialize in a technique of vasectomy that has been proven to reduce complications during- and after the operation:

No Scalpel

No Needle

Open-ended

No knife or surgical blade is used to cut the skin during the operation. I use only the “key-hole”- or “minimally invasive” surgical technique. This reduces pain and post-operative complications and facilitates faster recovery.

A needle is not used for local anaesthesia injection. I use a revolutionary “jet-spray”-instrument (MadaJet™) which delivers local anaesthetic fluid (lidocaine) into the skin without the need for a needle puncture. With this method, there is virtually no pain associated with the procedure.

The testicular end of the vas deferens is not tied but it is left open. This decreases the risk of developing “Post Vasectomy Pain Syndrome” and also improves the success rates of future vasectomy reversal, should a patient require it at a later stage.

Key Points: Vasectomy…

Is a minor surgical procedure with few complications.
Is intended to be a permanent form of contraception.
Does not produce immediate sterility. It takes about 2 – 4 months before you can be sure that you are sterile by having a microscopic examination of your semen (semen analysis test). For this reason, another form of contraception must be used until the post-operative semen analysis confirms sterility.
Does not cause erectile dysfunction (impotence), low levels of testosterone or a decrease in sex drive.
Is not always 100% reliable in preventing pregnancy. Even after successful vasectomy has been confirmed on semen analysis, there is still about a 1 in 3000 risk of pregnancy.
Options for fertility after vasectomy include microsurgical vasectomy reversal and in vitro fertilization.
The rates of surgical complications such as symptomatic haematoma and infection are about 1%.
Chronic scrotal pain / “Post Vasectomy Pain Syndrome” may occur in about 1% of patients after vasectomy.
Having a vasectomy does not increase a man’s risk of developing prostate cancer, testis cancer, heart disease, stroke or dementia.

Basic Anatomy

Sperms are produced and stored in the testicles. During sexual intercourse at the time of male orgasm, the sperms are rapidly transported from the testicle and are ejaculated. The thin tube that transports the sperm from the testicle is called the “vas deferens”. Each testicle has only one vas deferens.

During the vasectomy procedure, the vas deferens from each testicle is cut through and one end (abdominal end) tied off. This prevents any future transport of sperms away from the testicle. In other words, sperms are still being produced but they have no way of getting from the testicle to “the outside”, therefore rendering the male infertile (sterile).

The Vasectomy Procedure Step-by-Step

The majority of men who opt to have a vasectomy do so between the ages of 25 and 50 years – this is usually a time of having lots to get on with at work and at home. With this in mind, I have optimized the circumstances and technique of the vasectomy procedure to ensure a relaxed and stress-free operation day and rapid post-operative recovery.

Step 1: Local Anaesthesia – NO NEEDLE

No needle is used to inject local anesthetic into the area that will be operated on. I use the “Madajet Needle-Free Injector” to spray a high pressure jet of long-acting local anaesthetic (lidocaine) solution onto the scrotal skin on the exact spot where access to the vas deferens will be obtained.

The mist of anaestetic penetrates into the skin and underlying structures (vas deferens), achieving a complete numbing effect 12 times faster than with the conventional needle-injection anaesthesia technique. Apart from the benefit that patients are not subjected to the pain of a needle puncture in this very sensitive area of the body, another advantage of the “no needle” approach is that there is less trauma to the small nerves and blood vessels lying under the skin and around the vas deferens. Minimizing tissue trauma during an operation facilitates a decrease in post-operative pain, fewer complications and faster recovery.

no needle injection of local anaesthesia

Step 2: Access to the Vas Deferens – NO SCALPEL

After making sure that the area has been completely anaesthetized, a small surgical forceps with a very sharp tip is used to puncture the skin overlying the vas deferens. The opening in the skin is then dilated / opened up a few millimeters to allow a segment of the vas deferens to be pulled through the opening – a special forceps with a ring at the tip is used for this purpose.

Piercing skin overlying vas deferens

Opening up skin overlying vas deferens

Grasping vas deferens with ring retractor

Step 3: Removing a segment of vas and tying off one end only – OPEN ENDED

A 3cm piece of vas deferens is now pulled through the skin opening and a ± 1cm segment is cut out, using a surgical scissors. This leaves 2 open ends of vas deferens:

Abdominal end: The inside (lumen) of the abdominal end of the vas deferens is thermally disrupted (“mucosal cautery”) in order to prevent it from opening up and leading to vasectomy failure. The abdominal end is also closed by tying it with a surgical stitch (“ligation”). Furthermore, Performing these three measures (ligation, fascia interposition, mucosal cautery) ensures a very high success rate.

Testicular end: This end of the vas deferens is not closed with a stitch – it is left open (“Open-ended Vasectomy”). Leaving this piece open has been proven to reduce the risk of Post Vasectomy Pain Syndrome, which is a long-term painful and extremely bothersome reality for about 2% of men who are subjected to the traditional method of vasectomy.

International research has further showed that open ended vasectomy significantly improves the chances of successfully reversing the vasectomy, should patients change their mind and wish to have more children at some stage in the future.

As an extra measure of safety to make sure that the vasectomy does not fail, I stitch a small piece of muscle tissue that is normally situated next to the vas deferens over the tied-off end – this technique ( “fascia interposition”) has been proven to decrease the risk of vasectomy failure even more.

It is important to note that open ended vasectomy (combined with ligation, fascia interposition and mucosal cautery of the abdominal end) is just as effective in establishing male sterility as a vasectomy where both ends of the vas are tied off. So no compromise is made on the efficacy of the vasectomy by leaving one end open – it just has the added advantages outlined above.

Steps 1 to 3 should take altogether about 15 minutes to complete on both sides (left and right testicles). No stitches are needed to close the “no scalpel” openings in the scrotal skin – a small plaster is simply placed over each wound.

After the procedure and once my nursing staff has ensured that you are feeling relaxed and not in pain, you’ll be allowed to go home.

Recovery: Do’s and Don’ts

Better to take it easy for the first day or two. Go directly home after the operation and rest: elevate your feet. Plan to limit the time on your feet as much as possible for the first few days.
The local anaesthetic will wear off within about 3 hours after the operation and I will provide you with a prescription for pain medication and anti-inflammatories.
Locally applied ice packs in the first 24 hours as well as a tight scrotal support garment (like 2 pairs of tight-fitting underpants worn over one another) for a few days are very effective in preventing post-operative pain and swelling.
You will usually be given sick leave for 3 days but you may return to work earlier if you feel up to it and provided that your occupation does not involve physical exertion (lifting of heavy objects, walking long distances, standing for long periods).
You should avoid heavy physical activity for approximately 1-2 weeks and may resume sexual activity 1 week after the procedure.

It is very important that you continue to use another method of contraception for at least 2 months after the vasectomy AND until you’ve confirmed a sperm count of zero on a formal laboratory sperm count test.

Complications

Although vasectomy is a minor procedure, any surgery on the human body carries with it the risk of possible complications. A complication after vasectomy is uncommon. Even if it does occur, it is usually more bothersome than serious and is mostly managed conservatively (ie no surgical intervention required).

Haematoma / Bleeding

There is virtually no bleeding during the operation, but bleeding on the inside of the scrotum (wound haematoma) causing swelling and bruising may take place in the days following your surgery. Should this occur, management will usually involve a course of antibiotics and anti-inflammatory medication, as well as tight-fitting scrotal support. Most haematomas will resolve on their own and there will be no long-term effects. It is important that you take it easy for the first few days after your surgery in order to further reduce the risk of a wound haematoma. Using the No Scalpel vasectomy technique reduces the risk of post-operative haematoma.

Infection

There is no benefit in routinely taking a full course of oral antibiotics after your operation – in fact, this practice increases the resistance of germs to antibiotics. Wound infections may rarely occur after vasectomy, and will usually be managed with a course of oral antibiotics

Epididymitis

This is a condition that occurs when the epididymis (part of the testicular end of the vas), becomes inflamed and swollen. The use of anti-inflammatory medication with or without antibiotics usually clears this up within a week.

Post-Vasectomy Pain Syndrome (PVPS) / Chronic post-operative pain

Some degree of pain or ache in the first few days following a vasectomy is completely normal and is usually easily controlled with pain tablets. However, about 5% of men may have chronic scrotal pain for many years following a vasectomy. Because this is such a troublesome condition, numerous research articles have been published on the topic: There is no way to predict which patients will develop chronic pain after a vasectomy. There is also no specific treatment that is reliably effective. Many different things have been tried: stronger pain medication, different classes of pain medication, injection of local anaesthetic, surgically removing the nerves that conduct pain impulses from the testicle, reversing the vasectomy, and even removing the testicle! None of the mentioned treatment modalities have had a more than 70% success rate in curing the pain and discomfort. One thing that has been proven to reduce the risk of developing Post Vasectomy Pain Syndrome / PVPS is using the open-ended vasectomy technique. By leaving the testicular end of the vas deferens open, the sperm that is still produced by the testicle after vasectomy will not accumulate and cause high pressure, as is the case when the testicular end of the vas is closed off. High pressure in the vas and epididymis is widely accepted as the most probable cause of PVPS.

Sperm Granuloma

This may occur when sperm leaks from the open end of the testicular vas. A small lump (about 4mm) which is usually painless forms in the area. This lump does not pose a danger, rarely causes any symptoms and frequently resolves over time.

Failure of Vasectomy

Pregnancy may result if a man fails to abstain from sex or use alternative forms of birth control during the first few weeks after the operation, until a sperm count of zero has been confirmed on a formal laboratory sperm count test. There is also 1 in 2000 chance that the cut vas will spontaneously rejoin, thereby restoring the males fertility and causing pregnancy

Vasectomy does NOT cause

Sexual Difficulties

It is usually reported that men who undergo vasectomy and their partners express greater enjoyment and spontaneity of sex. However, occasionally a man may experience sexual problems after vasectomy, but these almost always have an emotional / psychological basis. Counseling usually alleviates the problem.

Low Testosterone

The male hormone testosterone is produced in the testicle and is transported to other areas of the body via the blood. Testosterone is not transported in the vas deferens and therefore vasectomy will not cause any change in a man’s testosterone levels.

Prostate Cancer, Testis Cancer, Heart problems, Stroke, Dementia

The Vasectomy Guideline Panel of the American Urological Association evaluated numerous research publications on the association between vasectomy and the abovementioned conditions. They concluded that vasectomy does NOT increase a man’s risk of developing any of these illnesses.

How successful is vasectomy?

Vasectomy an effective form of contraception in more than 99% of cases. When compared to other forms of birth control, it may well have the highest success rate, but it is still not 100% and pregnancy may occur after vasectomy.

The Vasectomy Guideline Panel of the American Urological Association has published a list of vasectomy techniques with a success rate of more than 99%: the No Needle, No Scalpel, Open Ended Vasectomy that I perform, is one of these recommended and approved surgical options.

The rare cases of vasectomy failure may be caused by the following:

Surgical failure

Failure of the surgeon to correctly remove a segment of the vas deferens is extremely uncommon. Some surgeons use a vasectomy technique where only a single opening is made in the scrotal skin and the vas deferens on both the left- and right sides are accessed through this single incision. It has been described that the surgeon may in some cases mistakenly remove 2 segments from one vas deferens, leaving the other side still intact and able to transport sperm.
The technique that I use involves 2 small openings in the scrotal skin – one over the left sided vas deferens and one over the right side. Making 2 separate openings prevents vasectomy failure due to the oversight described above.

Patient failure

Vasectomy does not make a man sterile immediately. Live sperms able to fertilize a female egg are often still present in the abdominal end of the vas deferens for several weeks after the vasectomy. For this reason it is absolutely essential for a couple to use an alternative form of contraception until sterility has been confirmed.
Between 2 and 3 months after vasectomy the first “Post Vasectomy Semen Analysis” (PVSA) should be performed. Only if this test shows no moving sperm, can the man be considered sterile and other forms of contraception be safely stopped.

Recanalization

This occurs when the severed ends of the vas deferens spontaneously grow back together, once again allowing the unobstructed transportation of sperm. This may occur weeks to years after vasectomy. Certain vasectomy techniques are known to have high recanalization rates and are not recommended by international experts.

I use the Open Ended vasectomy technique with Ligation, Fascia interposition and Mucosal cautery of the abdominal end. This technique is one of 3 which are all recommended by the American Urological Association, as they have the lowest recanalization rates (<<1%).

No-needle No-scalpel Vasectomy: || Procedure and Success Rates