Easy VasectomyⓇ: No Scalpel • No Needle • No Suture
Easy VasectomyⓇ is a simple, inexpensive, and effective form of permanent male contraception. It is safer, less invasive, and has fewer complications and quick recovery. Under local anesthesia, only a tiny puncture is made at the midline of the scrotum skin. The most popular type of vasectomy is the No-Scalpel Vasectomy..
Dr. Shu has performed almost 2000 no-scalpel vasectomies without any major complications and zero failure rate. He invented two-finger technique in facilitating the local anesthesia and holding the vas during the surgery.
EASY VASECTOMYⓇ CONSULTATION
A preoperative consultation on vasectomy is an important step in planning on vasectomy in Minnesota. Thanks to the Internet, the patients can get all information from a well designed high quality website.
Young patients may consider the consultation first before they make the final decisions on vasectomy.
The minimum and necessary concepts that should be discussed in a preoperative vasectomy consultation include the following: (based on American Urological Association Guideline).
- Vasectomy is intended to be a permanent form of contraception.
- Vasectomy does not produce immediate sterility, another form of contraception is required until vas occlusion is confirmed by post-vasectomy semen analysis.
- Even after vas occlusion is confirmed, the risk of pregnancy after vasectomy is approximately 1 in 2,000.
- Repeat vasectomy is necessary in ≤1% of vasectomies, provided that a technique for vas occlusion known to have a low occlusive failure rate has been used.
- Patients should refrain from ejaculation for approximately one week after vasectomy.
- Options for fertility after vasectomy include vasectomy reversal and sperm retrieval with in vitro fertilization. These options are not always successful, and they may be expensive.
- The rates of surgical complications such as symptomatic hematoma and infection are 1-2%. These rates vary with the surgeon’s experience and the criteria used to diagnose these conditions.
- Chronic scrotal pain associated with negative impact on quality of life occurs after vasectomy in about 1-2% of men. Few of these men require additional surgery.
- Other permanent and non-permanent alternatives to vasectomy are available.
BEFORE THE VASECTOMY
- Understand the “Post Vasectomy Instructions” so that you know what to expect.
- To prevent the possibility of increased bleeding, do not take aspirin or other blood thinners for 7 days before the procedure. May take Ibuprofen 3-4 tabs 1 hour before vasectomy
- Please shave the front wall of scrotum and underside of the penis and take a good shower before you leave home for vasectomy. You will be asked to refrain from doing so again until 2 days after your procedure.
- Don’t bring an athletic supporter, we provide you a free athletic supporter on the day of the procedure.
- Be prepared to sign the operative consent sheet upon your arrival in the office. Think of any questions you may want to ask your doctor.
- You are able to drive home by yourself after the surgery although a flat tire or fender bender could lead to complications.
- Eat before your procedure, a normal breakfast or lunch. Nervous men who do not eat beforehand are more likely to become lightheaded during or after their vasectomies.
DURING THE VASECTOMY
Conventional needle anesthesia in vasectomy involves the use of a 27 gauge needle to raise a wheal at the skin of scrotum; it is then advanced its full length along the vas on each side where further anesthetic solution is deposited. Dr. Shu uses the modern no-scalpel technique, exposing each vas in turn through a tiny opening in the front scrotal wall under local anesthesia. Since the opening is so small, it is easy to apply anesthesia without the use of needles. A spray applicator (MadaJet®) delivers a stream of anesthetic so fine that it penetrates the skin and diffuses to a depth of about 3/16 of an inch, enough to surround and anesthetize each vas tube in turn as it is lifted into position beneath the skin, attaining a close to 100% efficacy rate with no need for supplemental anesthetic.
The tiny opening in the dime-sized area of numb skin is made with a pointy hemostat: one tip makes a pinpoint opening, then the two tips are used to spread and enlarge the opening to about 1/4 of an inch. Since blood vessels in the skin are spread apart rather than cut, bleeding is less than when a scalpel is used, no stitches are required, and the opening is usually sealed closed (often barely visible) by the next day.
Once each vas tube is lifted through the small skin opening, it is divided under direct vision with fine pointy hemostat. Nothing is removed; the ends of the divided vas are placed out of alignment and kept from rejoining by applying a tiny clip to the sheath surrounding the vas so that one end stays inside the sheath, the other outside. The lining of the tube on upper end is destroyed with cautery (scarring it), the lower end is open without cauterization. While extremely effective (failure rate less than 1 in 2000), the technique provides for easier reversal (less scarring than when sutures are used) in men who choose reversal later in life. Procedure time is about 10 minutes. Most men say it hurts less than having a blood sample drawn. Many have called it painless.
Steps of Easy VasectomyⓇ:
With the patient lying down, the scrotum skin is cleaned with alcohol and a small amount of local anesthesia is placed into the scrotal skin with a fine needle or needleless pressure spray applicator around the vas deferens. Then the scrotum and its surrounding areas are prepped with Betadine.
Dr. Shu begins the procedure on the right side by gently bringing the vas deferens to a position just under the scrotal skin. A tiny puncture is made in the numbed area of scrotal skin. The vas deferens are then secured and pulled out with a ring clamp through the small opening. The surrounding fascia is stripped with a sharp instrument to expose the vas deferens.
Dr. Shu uses 3 steps to insure complete occlusion: he cuts the vas deferens and destroys the lining of the tube on each end with cautery (scarring it) and places small titanium clips in the vas fascia to separate the opened ends of vas deferens. The vas deferens are then placed back into the scrotum in its normal anatomic position.
AFTER THE PROCEDURE
1. Antibiotic ointment, gauze and an athletic supporter will be placed over the wound immediately following the procedure. Continue to apply the antibiotic ointment daily until the skin puncture site is completely healed.
2. Once you return home after the surgery. Reclining in bed or on the sofa , Minimizing activity. Read your doctor’s written instructions, No need for ice packs. You may shower and spend more time walking on the second day.
3. The athletic supporter should be worn for at least the first 24 hours or whenever you are up and around for the next 2 days, during sports for the next 7 days. Heavy lifting or vigorous physical activity should be avoided for 1 week.
4. Two days after the procedure, you may return to office work and regular activities. Since no incision is made, a follow-up visit is not required.
5. You may have sexual intercourse 1 week after the procedure. It is uncommon but normal to have some blood in the semen or mild pain for the first few ejaculations.
6. Patients often notice mild scrotal swelling and bruise in the first week following the surgery. The swelling often increases with activity, and may be relieved by wearing the athletic supporter and resting. If the scrotal sac is significantly bruised and expanding in size, please contact the office 952-922-2151.
7. If you experience pain or discomfort, you may take ibuprofen (Advil) 200mg 3 or 4 tablets, 3 times a day with food, and acetaminophen (Tylenol) 2 tablets every 4 hours. If you experience increasing pain, please contact us at 952-922-2151.
8. Infection is very uncommon following the no-scalpel vasectomy procedure. Contact Dr. Shu if you notice excessive redness, tenderness, warmth or drainage from your surgical site.
9. Some men develop a small, tender nodule where the vas was cut. These sperm granulomas can produce discomfort, but almost always resolve spontaneously. You can have the site re-examined if you are concerned.
10. A semen examination should be performed to document the success of the surgery, testing is done in one of two ways:
a. If you live or work close to our clinic, we will provide you with a container and ask you use it to bring a semen sample to the office 12 weeks and 20 ejaculations after your vasectomy. (Number of ejaculations and time are both important, so a semen sample brought in before 12 weeks is less likely to be free of sperm.) If you lose the container that we provide, you may use a small container with a lid, such as a pill bottle, baby food jar, 35 mm film canister, etc. Please do not bring the sample in a condom or baggie as we will be unable to retrieve an adequate specimen and you will be asked to return with another sample in a container with a lid. The sample should be produced on the day of examination, but can be 3 or 4 hours old. You may bring the sample anytime during regular office hours (8:00 – 5:00). If sperm are seen, you will be asked to continue other means of birth control and to return with a second specimen in 3-6 weeks. After twelve weeks and 20 ejaculations (both), 98% of men will have no sperm in their semen. Two percent will have to repeat the test at least once.
b. If you live and work far from our clinic, we will provide you with a mailer so you can send us a semen sample by mail, at least twelve weeks and 20 ejaculations after your vasectomy.
11. Another form of contraception (such as condoms) should be used until you have been notified by us that your 12 week post procedure semen examination showed no sperm.