Physician's Weekly (Surgery Edition. March 6, 2006)

Advances in Vasectomy: No Needle, No Scalpel... No Problems?

(Sources: This article was edited by Mr. Keith D'Oria, Managing Editor, Physician's Weekly. March 6, 2006 Vol.III, No.10. Mr. Keith D'Oria can be reached by email at keithd@physweekly.com)

A no needle technique that delivers local anesthesia in patients undergoing vasectomy appears to be a simple and safe approach that yields high patient satisfaction. The hope is that eliminating needles will decrease the fear of needles in men electing for a vasectomy.

Vasectomy is the one of the safest and most dependable methods of permanent contraception available to men. It is estimated that about 500,000 vasectomies are performed each year in the United States. With the traditional technique for vasectomy, surgeons usually require 20 to 30 minutes to complete the procedure. Patients can return to work fairly quickly, but they do have some pain. Moreover, research has indicated that 1% of traditional procedures have complications, which include bleeding, hematoma, and infection.

In 1975, Li Shunqiang, MD, developed the no scalpel vasectomy in China. Since that time, the procedure has been adopted in the United States and about 15 million Americans have undergone a no scalpel vasectomy. In addition to being an effective contraceptive, clinical studies have shown that it is associated with a 10-fold reduction in complications when compared with standard vasectomy.

A no needle, no scalpel vasectomy is a unique and nearly painless technique for anesthetizing the scrotal skin and the vas deferens. An anesthetic solution is sprayed through the skin and around the vas deferens using a high pressure jet injector (Table 1). According to Marc Goldstein, MD, FACS, patients describe the sensation of the no needle, no scalpel procedure as "a gentle snap of a rubber band against the scrotal skin." He says "the technique delivers local anesthesia for vasectomy with less pain, which is important because most men are afraid of the needle puncture involved in traditional vasectomy. After the procedure, patients often return to their daily routine within just a few days because there is little or no pain and because no stitching is involved."

Additionally, the no needle, no scalpel vasectomy takes an average of about seven minutes to complete for an experienced surgeon, according to Dr. Goldstein. "Another key advantage is that it requires the use of less lidocaine. Only 0.6 cc of an anesthetic are required because it's more directly targeted to the treatment area [Table 2]. A cone-shaped distribution of the anesthetic is administered and provides effective anesthesia. In turn, the patient experiences much less postoperative swelling."

Learn the No Scalpel Approach First

According to Dr. Goldstein, mastering the no scalpel procedure is necessary before surgeons can begin to learn the no needle, no scalpel vasectomy. "The traditional vasectomy is simple in that we can find the vas deferens more easily when a large incision is made. But the no scalpel approach is all based on feeling the vas deferens and trapping it between the fingers using the three-finger fixation technique. It's a learning curve that requires much experience."

Accurate placement of the high pressure jet injector is important when learning the no needle, no scalpel vasectomy, according to Dr. Goldstein. "Surgeons can actually inject themselves in the finger with the anesthetic if they fail to place the injector in exactly the right place. However, surgeons can minimize this risk as they become more experienced using the technology."

Can All Patients Receive No Needle, No Scalpel Vasectomy?

According to Dr. Goldstein, most patients seeking a vasectomy can undergo the no scalpel approach. "The only patients who would be excluded from having this procedure would be those who have had extensive prior scrotal surgery. Previous surgery can make it difficult for surgeons to totally visualize the vas deferens. Also, there may be a contraindication if the patient exhibits prior scarring from scrotal surgery or if they have cryptochidism. In the 20 years that I have been performing no scalpel vasectomy, I have had just two patients who have been unable to have the procedure."

With regard to the no needle, no scalpel vasectomy, Dr. Goldstein says that patients are eager to undergo this less invasive procedure. "However, only about two or three institutions in the United States currently have the capability to perform the no needle, no scalpel vasectomy. It may take some time before the procedure becomes more widely available because physicians must acquire the instrumentation and learn the proper technique. The instruments must also be maintained perfectly in order to be utilized safely and effectively. It's a good practice to have at least two high pressure jet injectors so that an alternative is available should one fail during the procedure."

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