No scalpel vasectomy
|No scalpel vasectomy|
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 to access the vas deferens instead of giving an incision as in conventional vasectomy. This offers several benefits, the key being that there is 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.
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 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. 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 Government of India then proceeded to introduce the procedure in every district of India as an alternative to tubal ligation offered to women.
No scalpel vasectomy is a day case (outpatient) procedure and the patient is fit to go home the same day.
No scalpel vasectomy is for all practical purposes irreversible.
Eligibility criteria in India
The Government of India stipulates more stringent criteria:
- Should be 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
No scalpel vasectomy is performed under local anaesthesia. Usually lidocaine 2 percent is infiltrated into the vas deferens and the puncture site on the scrotum. This makes the procedure pain free. Some patients may prefer to receive regional anaesthesia.
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 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 deferens and deliver it outside. It is then occluded and ligated.
Methods of ligating and occluding the vas deferens
Several methods have been described to occlude the vas deferens:
No method has been shown to be superior.
This procedure has less pain, bleeding and infection than conventional vasectomy. No scalpel vasectomy can be done in less time and the individual is able to return to sexual activity sooner than traditional vasectomy surgery.
Possible complications are:
- Cook, Lynley A.; Pun, Asha; Gallo, Maria F.; Lopez, Laureen M.; Van Vliet, Huib AAM (2007). "Scalpel versus no-scalpel incision for vasectomy". Cochrane Database of Systematic Reviews (2): CD004112. doi:10.1002/14651858.CD004112.pub3.
- Shattuck, Dominick; Perry, Brian; Packer, Catherine; Chin Quee, Dawn (23 December 2016). "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.
- No-Scalpel Vasectomy: An Illustrated Guide for Surgeons (PDF). New York: Engender Health. 1997. Retrieved 17 November 2016.
- "World Vasectomy Day" (PDF).
- Sharlip, Ira D.; Belker, Arnold M.; Honig, Stanton; Labrecque, Michel; Marmar, Joel L.; Ross, Lawrence S.; Sandlow, Jay I.; Sokal, David C.; American Urological Association (December 2012). "Vasectomy: AUA guideline". The Journal of Urology. 188 (6 Suppl): 2482–2491. doi:10.1016/j.juro.2012.09.080. ISSN 1527-3792. PMID 23098786.
- "Government of India Eligibility criteria for No Scalpel Vasectomy". drvijayantgovinda.com.
- Cook, Lynley A.; Van Vliet, Huib A. A. M.; Lopez, Laureen M.; Pun, Asha; Gallo, Maria F. (30 March 2014). "Vasectomy occlusion techniques for male sterilization". The Cochrane Database of Systematic Reviews (3): CD003991. doi:10.1002/14651858.CD003991.pub4. ISSN 1469-493X. PMID 24683020.
- "Complications of No Scalpel Vasectomy". drvijayantgovinda.com.