No-scalpel vasectomy (also called non-scalpel vasectomy, keyhole vasectomy or NSV) is a type of

vasectomy Vasectomy, or vasoligation, is an elective surgical procedure for male sterilization or permanent contraception. During the procedure, the male vasa deferentia are cut and tied or sealed so as to prevent sperm from entering into the urethra and ...

procedure in which a specifically designed ringed clamp and dissecting

hemostat A hemostat (also called a hemostatic clamp, arterial forceps, or pean after Jules-Émile Péan) is a surgical tool used in many surgical procedures to control bleeding. For this reason, it is common in the initial phases of surgery for the initia ...

is used to puncture the

scrotum The scrotum or scrotal sac is an anatomical male reproductive structure located at the base of the penis that consists of a suspended dual-chambered sac of skin and smooth muscle. It is present in most terrestrial male mammals. The scrotum cont ...

to access the

vas deferens The vas deferens or ductus deferens is part of the male reproductive system of many vertebrates. The ducts transport sperm from the epididymis to the ejaculatory ducts in anticipation of ejaculation. The vas deferens is a partially coiled tube ...

. This is different from a conventional or incisional vasectomy where the scrotal opening is made with a

scalpel A scalpel, lancet, or bistoury is a small and extremely sharp bladed instrument used for surgery, anatomical dissection, podiatry and various arts and crafts (either called a hobby knife or an X-acto knife.). Scalpels may be single-use disposa ...

. The NSV approach offers several benefits, including lower risk for bleeding, bruising, infection, and pain. The NSV approach also has a shorter procedure time than the conventional scalpel incision technique. Both approaches to vasectomy are equally effective. Because of the inherent simplicity of the procedure it affords itself to be used in

public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...

programs worldwide. This method is used in over 40 countries for male sterilisation.

History

No-scalpel vasectomy was developed and first performed in China by Dr. Li Shunqiang with the aim of reducing men's fear related to the incision and increasing vasectomy use in China. In 1985, a team created by

EngenderHealth EngenderHealth is a 501(c)(3) nonprofit organization based in Washington, D.C. active in sexual and reproductive health (SRH) operating in nearly 20 countries throughout Africa, Asia, and the Americas. The organization was established in 1943 a ...

visited his centre to learn the technique. One of the team members, Dr. Phaitun Gojaseni, introduced the no-scalpel technique in Thailand upon his return, while another member of the team, Dr. Marc Goldstein, introduced the technique to the United States at the

NewYork–Presbyterian Hospital The NewYork-Presbyterian Hospital is a nonprofit academic medical center in New York City affiliated with two Ivy League medical schools, Cornell University and Columbia University. The hospital comprises seven distinct campuses located in the New Y ...

. Over time, the technique gained popularity and it is now a preferred method of male sterilization in many countries.

History of no-scalpel vasectomy in India

No-scalpel vasectomy was introduced in India in 1998. A team of Indian surgeons lead by Dr RCM Kaza travelled to Chengdu, China, to learn the technique under the aegis of EngenderHealth and the UN. They then introduced the procedure in India, under the

National Rural Health Mission The National Health Mission (NHM) was launched by the government of India in 2005 subsuming the National Rural Health Mission and National Urban Health Mission. It was further extended in March 2018, to continue until March 2020. It is headed b ...

. The

Government of India The Government of India (ISO: ; often abbreviated as GoI), known as the Union Government or Central Government but often simply as the Centre, is the national government of the Republic of India, a federal democracy located in South Asia, c ...

then proceeded to introduce the procedure in every district of India as an alternative to

tubal ligation Tubal ligation (commonly known as having one's "tubes tied") is a surgical procedure for female sterilization in which the fallopian tubes are permanently blocked, clipped or removed. This prevents the fertilization of eggs by sperm and thus th ...

offered to women.

World Vasectomy Day World Vasectomy Day (WVD) is an annual event to raise global awareness of vasectomy as a male-oriented solution to prevent unintended pregnancies. The goal is for doctors all over the world to perform vasectomies, connected to the event via Skype ...

is celebrated on 7 November in India.

Technical procedure

No-scalpel vasectomy is a day case (

outpatient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care ...

) procedure and the patient is fit to go home the same day. The eligibility criteria for the no-scalpel vasectomy and the conventional vasectomy procedure are the same, although may vary from clinic to clinic.

Anaesthesia

No-scalpel vasectomy is performed under

local anaesthesia Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It ...

. Usually

lidocaine Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or in nerve blocks, lidoca ...

2 percent is infiltrated into the

and the puncture site on the scrotum. This makes the procedure pain free. Some patients may prefer to receive

regional anaesthesia Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It ...

Steps

The vas deferens is isolated by three-finger technique on both sides. The ideal entry point for the needle is midway between the top of the

testes A testicle or testis (plural testes) is the male reproductive gland or gonad in all bilaterians, including humans. It is homologous to the female ovary. The functions of the testes are to produce both sperm and androgens, primarily testoster ...

and the base of the

penis A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males do n ...

. Usually, 100 mg

(without

epinephrine Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands and ...

) is injected to create a wheal. The no-scalpel vasectomy uses two specific instruments designed by Dr. Li Shunqiang. One is a ringed clamp and the other is a dissecting forceps. The ringed clamp is used to isolate and encircle the vas. The dissecting forceps is used to puncture the scrotal skin, spread tissues, and pierce the vas deferens to deliver it outside the scrotum. The vas deferens is then occluded.

Methods of occluding the vas deferens

The most commonly used methods to occlude the vas deferens include: * Fascial interposition or burying one end of the cut vas deferens under tissue * Folding back or folding and tying each end of the vas deferens so they do not face one another * Tying with either sutures or clips * Cauterising of one or both ends The American Urological Association recommends occlusion by one of the following methods to achieve highest efficacy: * Cautery with or without fascial interposition * Open ended vasectomy with one end of the vas open; the other end with cautery and fascial interposition * Extended electrocautery

Complications

No-scalpel vasectomy has less pain, bleeding and infection than conventional vasectomy. No-scalpel vasectomy can also be done in less time and the individual is able to return to sexual activity sooner than traditional vasectomy surgery. However,

sperm Sperm is the male reproductive cell, or gamete, in anisogamous forms of sexual reproduction (forms in which there is a larger, female reproductive cell and a smaller, male one). Animals produce motile sperm with a tail known as a flagellum, whi ...

may still be present for 10–20 ejaculations, and some doctors may schedule a follow-up visit to confirm the success of the procedure. Additionally, there is approximately a 1 in 2,000 chance of pregnancy following a vasectomy, as some sperm may be able to cross the severed vas deferens. Complications are rare and can include: * Bleeding * Hematoma (bruise) * Surgical site infection * Orchalgia (long-term pain of the testes)

References

{{reflist Sterilization (medicine) Male genital surgery Family planning Contraception for males Vasectomy