No-scalpel Vasectomy in Bhubaneswar: Procedure

Vasectomy, a surgical procedure performed on a male to make him sterile, is one of the most common surgical procedures worldwide. This procedure is one of the most effective methods of birth control because it prevents sperm from mixing with the semen in the penis. Vasectomy can be performed by scalpel, no-scalpel, laser, or vas clip techniques. In a no-scalpel vasectomy method, the surgeon does not use a scalpel (hence the name) to make incisions on the scrotal skin, but a hole/puncture is made on the scrotal skin by other tools to access the vas deferens. . Surgeons have popularly used the no-scalpel vasectomy method since the 1980s, as it is a less invasive procedure with minimal bleeding and a faster recovery.

A No-scalpel vasectomy is a minor, outpatient, and minimally invasive male sterilization procedure in which the surgeon uses a clamp to hold the vas deferens from outside the scrotum (a part of the male reproductive system located beneath the penis that contains and protects the testes), and a puncture/hole is made in the scrotal skin to access the vas deferens ( a tube that carries the sperm to the penis). The testes (plural) are two egg-shaped glands inside the scrotum that contains sperm. 

Unlike a traditional (conventional) vasectomy, in the No-scalpel method, no incision is made on the scrotum's skin to reach the vas deferens. A non-scalpel vasectomy has the advantages of having less bleeding, a lower risk of developing complications, minimal pain after the surgery, and a quicker recovery. You should know some facts about a no-scalpel vasectomy:

• It is a permanent sterilization method, meaning you do not have to use contraception during intercourse after getting a vasectomy.
• Your sex drive will not be affected- you will be able to have intercourse, ejaculate, and produce semen, but your semen will be devoid of sperms (you will not be able to make your partner pregnant; pregnancy occurs when the sperm from the male fertilizes the egg released from the female). Hence, you cannot father any children. 
• It is a permanent sterilization method, so be sure before getting it done, as it cannot be reversed.
• It will not protect you against sexually transmitted infections (STIs), so always use a condom during intercourse. 

Conventional and No-scalpel vasectomy are procedures for male sterilization, and after undergoing the surgery, the sperm cannot move out of the testes (two egg-shaped glands inside the scrotum containing the sperm) and the body. Even though they aim to prevent the sperm from mixing with the semen, there is a difference in both procedures.

No-scalpel vasectomy is recommended if:

• You are sure that you do not want any children in the future.
• You are over 30 years old and have children.
• Getting your partner pregnant would cause risk to her health (she would have medical problems if she becomes pregnant) 
• You and your partner have a genetic disorder ( to reduce the chances of the offspring inheriting the disorder) 

Preparation for a No-scalpel vasectomy is essential both for you and the doctor, to plan the surgery well. Here are a few pointers that would be done.

• Your doctor will review your medical and family history to understand why you are opting for the procedure
• A physical examination will be performed to check your overall health once you are sure about undergoing the procedure.
• Your doctor will ask you to discuss this with your partner before consenting to the procedure.
• Your doctor will also discuss your sexual history to counsel you and determine whether it is the right procedure.
• Your doctor will also inform you about the benefits, risks, and aftercare that needs to be taken after a conventional vasectomy.
• Inform your doctor about medications, vitamins, herbs, or supplements you may be taking or any medication allergies.
• Your doctor may ask you to stop certain medications like blood thinners one week before the procedure to prevent bleeding during or after the procedure.
• You will be advised to do routine blood tests, urine examinations, chest X-rays, and electrocardiograms (ECG) to assess your overall condition before the procedure.
• You should have a light meal the night before the procedure.
• You must arrange for someone to drive you back home as you will be drowsy from the effect of anesthesia.

No-scalpel vasectomy is a quick, safe, minimally invasive outpatient procedure that takes about 30 minutes. It is usually done at the hospital by a skilled urologist (a doctor specializing in diseases of the male reproductive tract and the urinary system) under local anesthesia, meaning you'll be awake during the procedure and feel no pain. 

On the day of the procedure, you would be advised to:

• Shower at home before coming to the hospital.
• Wear comfortable cotton and loose clothing.
• Remove any jewelry and make-up before coming for the procedure
• Bring a supportive undergarment to wear after the surgery.
• Sign a consent form stating your consent for the surgery.
• Trim your scrotal hair before the procedure / the hospital staff may do it.

The Procedure

• You will be asked to empty your bladder before the procedure.
• You will be wheeled into the operation theatre (OT) and made to lie supine on the OT table.
• Your surgeon will use an anesthetic spray over the scrotal area. Some surgeons may inject a local anesthetic into the scrotal area. This will numb the area, and you will not feel any pain. Your surgeon may give you a mild sedative to ease your anxiety.
• Your surgeon will feel for the vas deferens with the hands under the skin. On locating the vas deferens, a special clamp be used from outside to hold them in place.
• A hemostat will be used (a locking forceps with a sharp tip), or another tool is to make a small hole in the skin of the scrotum. The vas deferens are pulled out through the holes.
• A small piece will be cut, and the cut ends of the vas deferens will be tied together by using heat (cauterization), surgical clips, tying it off (ligation), or inserting a tissue between them.
• During the conventional and no-scalpel procedure, your surgeon will give you an option also to have an “open-ended” procedure which means that the prostatic end of the vas deferens will be tied/cauterized and the end that is close to the testis (testicular end) will be left open to facilitate sperm leakage; Studies have shown that this technique prevents the thickening of the sperm quantity as the sperms can flow into the testes and be absorbed by the testes. This results in a decrease in post-operative pressure and pain.
• Then, the vas is put back into the scrotum, and the small opening is left to heal.
• The surgeon will repeat the same procedure on the other vas deferens.

After the surgery, you will be shifted to the postoperative care unit (PACU), where your vitals (pulse, heart rate, respiration, and blood pressure) will be monitored. Ice packs will be applied over the area to reduce swelling, and painkillers will be given for relief. Once your vitals are stable, you will be allowed to go home. Your surgeon will instruct you on the care to be taken at home:

• You will be advised bed rest for 24 hours.
• You may have mild swelling, pain, and bruising over the incision site, which usually will subside within a few days with medications. 
• To reduce the swelling, apply ice packs to the scrotum for the first two days. Do not apply ice directly on the wound, as it may cause an ice burn. Take ice cubes and keep them in a plastic bag. Wrap a towel on the plastic bag and then apply it.
• You will be asked to wear tight-fitting underwear to support the scrotum (you can use a jockstrap)
• Keep the wound area clean and dry. It will close in a few days by itself. Your surgeon will prescribe an ointment to be applied over the wound for quick healing.
• Support your scrotum with a bandage and tight-fitting underwear for at least 48 hours after your vasectomy.
• Limit any strenuous activity such as weight lifting and jogging for at least 1 week. You can start walking and light exercises after 2 to 3 days.
• Refrain from intercourse/ejaculation for one week. After a week, it is advisable to use another method of contraception while having intercourse until cleared by your surgeon.
• You can resume work the next day after the procedure.
• Your surgeon will ask you for your semen sample to test for the presence of any sperm. If it is negative, then the procedure is considered successful.
• Complete recovery takes less than a week.

No scalpel vasectomy is a safe, minimally invasive, and effective procedure with many benefits. Side effects and complications are few. Research has shown that compared to conventional vasectomy, the chances of developing infections, hematomas, and complications are five times fewer.

Benefits

• It is a safe, minimally invasive, effective, permanent, and reliable method of birth control.
• It is a quick procedure done under local anesthesia that takes 20 to 30 minutes - you can go home the same day.
• There is no risk of complications developing after anesthesia as general anesthesia is not used (performed under local anesthesia).
• There is less bleeding and pain as no sutures are applied
• The procedure does not affect your overall health.
• Your sexual drive and ejaculation are not affected.
• The chances of complications are less.
• Recovery is quick and takes less than a week.

Risks

Complications of a no-scalpel vasectomy are not serious or uncommon, but sometimes they can include:

• Infection at the incision site with inflammation and bruising of the area. 
• A feeling of discomfort and pain in a testicle
• Formation of a sperm granuloma (a hard lump or inflammation caused by leakage of the sperm), spermatocele (a cyst in the tube that collects sperm), or a hydrocele (a sac of fluid around a testicle causing swelling in your scrotum).
• Epididymitis (inflammation of the duct behind the testicles through which the sperm passes to the vas deferens.
• Vasovenous fistula (when multiple blood vessels adhere to the vas deferens, causing injury).
• Failure of the procedure (when viable sperm are seen in the semen sample after vasectomy).

Also Read: circumcision

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