No Scalpel Vasectomy (NSV) - Video

Preoperative preparation: Following medical conditions must be ruled out -

1. Local infection—including scrotal skin infection, active sexually transmitted infection (STI), balanitis, epididymitis, or orchitis
2. Previous scrotal injury
3. Systemic infection or gastroenteritis
4. Large varicocele
5. Large hydrocele
6. Filariasis; elephantiasis
7. Local pathological condition (e.g., intrascrotal mass, cryptorchidism, or inguinal hernia)
8. Bleeding disorders
9. Diabetes
10. AIDS

Requirements: Warm room temperature to relax the scrotum - The temperature of the operating room should be at least 70 to 80 degrees F (approximately 20 to 25 degrees C)

Instruments:

1. Ringed clamp
2. Dissecting forceps
3. Straight scissors

Supplies:

1. Scissors for scrotal hair clipping
2. Sterile gloves
3. Antiseptic solution for cleaning the operative area
4. Sterile drapes
5. 10-cc syringe with a 1 & 1⁄2-inch, 25- or 27-gauge needle
6. 1% or 2% lidocaine without epinephrine
7. Supplies for vasal occlusion according to the surgeon’s preference (examples: a cautery unit; chromic catgut or nonabsorbable silk or cotton for ligation)
8. Sterile gauze
9. Adhesive tape or Band-Aid for dressing the wound

Anesthesia: 

1. After making the superficial skin wheal, advance the needle parallel to the vas within the external spermatic fascial sheath toward the inguinal ring.
2. Advance the full length of the needle, 1 & 1⁄2 inches, without releasing any of the anesthetic. Gently aspirate to ascertain that the needle is not in a blood vessel.
3. Without withdrawing the syringe, slowly inject 2 to 5 cc (depending on concentration) of lidocaine within the external spermatic fascial sheath around the vas deferens.
4. When the needle is in proper position and the injection is performed inside the external spermatic fascia, there is no resistance to the injection.
5. Epinephrine is not recommended because it contracts the blood vessels and results in less apparent bleeding at the time of surgery
6. The maximum individual dose of lidocaine without epinephrine should not exceed 4.5 mg/kg (2 mg/lb) of body weight.

Procedure:

1. Apply ringed clamp to scrotal skin: Using the three-finger technique, tightly stretch the skin overlying the vas. Apply the ringed clamp, with the shaft at a 90-degree angle perpendicular to the vas.

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