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No-scalpel vasectomy

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No-scalpel vasectomy (also called keyhole vasectomy or NSV) is a vasectomy procedure variant in which a sharp hemostat is used to puncture the scrotum[1] to access the vas instead of giving an incision as in conventional vasectomy. This offers several benefits, key being no need for surgical sutures to close the skin. Because of the inherent simplicity of the procedure it affords itself to be used in public health programs worldwide.This method is used in over 40 countries for male sterilisation.[2]

History

No-scalpel vasectomy was developed in China by Dr. Li Shunqiang with the aim of reducing men’s fear related to the incision and increasing vasectomy use in China[3]. No-scalpel vasectomy was developed and first performed in China in 1974 by Dr. Li Shunqiang of the Chongqing Family Planning Scientific Research Institute, located in Sichuan Province primarily in response to the fear of chinese men to undergo vasectomy.[4] Under the sponsorship of EngenderHealth, an international team of experts visited Dr. Li Shunqiang in 1985 and observed his refined vasectomy technique. They were convinced that the technique should become the standard approach for vasectomy. 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, performed the first no-scalpel vasectomy in the United States at the New York Presbyterian Hospital. Over time, the technique gained popularity and it is now a preferred method of male sterilization in many countries[4].

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 Engender Health and UN. They then introduced the procedure in India, under the National Rural Health Mission. The Government of India then proceeded to introduce the procedure in every district of India as an alternative to tubal ligation offered to women.

7th November every year is celebrated as World Vasectomy Day in India.[5]

Technical Procedure

No Scalpel vasectomy is a day care procedure and the patient is fit to go home the same day.

Eligibility Criteria

No scalpel vasectomy is for all practical purposes irreversible. Thus, it is recommended that the man have a living child before proceeding for the surgery. The Government of India, stipulates more stringent criteria than just this simple fact.[6]

    • Should be ever married
    • Should be above 22 years of age and less than 60 years of age
    • Should have at least one living child above 1 year of age (to pass the age of infant mortality)
    • Should be mentally sound to understand and give consent
    • Should not be coerced or under any pressure

Anaesthesia

No scalpel vasectomy is performed under local anaesthesia. Usually Lidocaine 2 percent is infiltrated into the vas and the puncture site on the scrotum. This makes the procedure pain free. Some patients may prefer to receive regional anaesthesia.

Steps

The vas is isolated by three-finger technique on both sides. The ideal entry point for the needle is midway between the top of the testes and the base of the penis. Usually, 100 mg lidocaine (without epinephrine) is injected to create a wheal. Afterwards, a ringed clamp is used to puncture the scrotal skin and elevate the vas deferens. A dissecting forceps is used to spread the tissue, pierce the wall of the vas and deliver it outside. It is then occluded and ligated.[4]

Methods of ligating and occluding vas

Several methods have been described to occlude the vas which include

  • Cutting and tying
  • Tying only
  • Cauterising the cut end
  • Harmonic Scalpel
  • Injection of Fibrin Glue

The superiority of either method has to be still proven.

Complications

This procedure has less pain, bleeding and infection than conventional vasectomy. NSV can be done in less time and the individual is able to return to sexual activity sooner than traditional vasectomy surgery.

But still complications are known such as

References

  1. ^ LA, Cook (2007). "Scalpel versus no scalpel incision for vasectomy" (PDF). Cochrane Library (4). Retrieved 17 November 2016.
  2. ^ Shattuck, Dominick; Perry, Brian; Packer, Catherine; Chin Quee, Dawn (2016-12-23). "A Review of 10 Years of Vasectomy Programming and Research in Low-Resource Settings". Global Health, Science and Practice. 4 (4): 647–660. doi:10.9745/GHSP-D-16-00235. ISSN 2169-575X. PMC 5199180. PMID 28031302.{{cite journal}}: CS1 maint: PMC format (link)
  3. ^ Huber, D. H. (April 1988). "A short history of no-scalpel vasectomy". AVSC news (Association for Voluntary Surgical Contraception (U.S.)). 26 (1): 1, 3. PMID 12269069.
  4. ^ a b c No-Scalpel Vasectomy : An Illustrated Guide for Surgeons (PDF). New York: Engender Health. 1997. Retrieved 17 November 2016.
  5. ^ "World Vasectomy Day" (PDF). {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)
  6. ^ "Government of India Eligibility criteria for No Scalpel Vasectomy". drvijayantgovinda.com. {{cite web}}: Cite has empty unknown parameter: |dead-url= (help)
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