Vasectomies are safer and more cost-effective than tubal ligations, the sterilization technique for women, but remain relatively underused.
A new no-scalpel vasectomy technique significantly reduces complications.
A tiny puncture and a little snip, done under local anesthetic — that’s essentially all there is to a vasectomy.
“Vasectomies are the safest, simplest, most cost-effective method of contraception we have,” said Dr. Edmund Sabanegh Jr., director of the Clinic for Male Fertility at the Cleveland Clinic Foundation.
They are also strikingly little-used. About 500,000 American men have the operation each year. More than twice as many women undergo tubal ligation for permanent contraception, even though that operation costs three to four times as much, requires general anesthesia and an abdominal incision, and carries a small but real risk of serious complications.
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The chief advance is the no-scalpel vasectomy, a technique pioneered in China in the 1970s that has been steadily gaining popularity in the United States. In a traditional vasectomy, doctors make two half-inch incisions on either side of the scrotum to sever the vas deferens, the two narrow tubes that carry sperm from the testicles during ejaculation. The no-scalpel approach does away with the need for incisions.
In the new technique, doctors use their fingers to locate the vas deferens by feel through the thin skin of the scrotum.
“Once we’ve located the vas, we make a tiny poke-hole over it,” said Dr. Phillip Werthman, director of the Center for Male Reproductive Medicine and Vasectomy Reversal in Los Angeles. The hole can be gently expanded in a way that pushes blood vessels aside rather than cutting through them, so there is almost no bleeding. Using a hooked instrument, surgeons pull the vas through the hole, then cut it.
“A lot of men can’t even tell where the procedure was done afterwards, the hole we make is that small,” said Dr. Goldstein, who was the first Western doctor to travel to China to learn the technique. Compared with traditional techniques, no-scalpel vasectomies result in less bleeding, less postoperative pain and quicker recovery. They also require less time to perform — a little more than 10 minutes in the hands of an experienced surgeon.
Although the traditional incision method is still more widely used, that is likely to change as more and more medical schools teach the no-scalpel approach.
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With current techniques, the chance of an unwanted pregnancy occurring in the first year after a vasectomy is 1 in 1,000, Dr. Sabanegh said. Some of those failures are the fault of the patient, not the procedure. Because it can take several months for sperm remaining after a vasectomy to be washed out, men are counseled to use other contraception methods until tests show that their semen is free of active sperm. Many men don’t bother. In a 2006 study of 436 vasectomies, researchers at the Cleveland Clinic Foundation found that only three out of four returned for follow-up semen analysis, and only 21 percent followed the full instructions to continue to be tested until two specimens came up negative.
http://health.nytimes.com/ref/health/healthguide/esn-vasectomy-ess.html?ref=healthI had the "new" no-scalpel vasectomy done twenty years ago and it took maybe 10-15 minutes and other than a slight "pulling" sensation, I didn't feel a thing. Very easy and went straight back to work.
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