Optimizing the Modified No-Scalpel Vasectomy Technique

The scope of our research is andrology, where we would like to answer these questions about the key points of this surgery. This surgery's challenge is to trip and clamp the vas deferens using the fixation ring clamp. This approach can help operating zones without electric cautery equipment to perform vasectomy.

To perform vasectomy, select a patient with normal bilateral vas deferens development, confirmed by color Doppler ultrasonography. After performing bilateral spermatic nerve blocks, use the three-finger technique to firmly trap the vas deferens under the thumb and index finger of the left hand and over the middle finger. To fix the right vas deferens below the median raphe, flatten the scrotal skin over the vas deferens.

Clamp the vas deferens using an extra cutaneous fixation ring clamp with the right hand. Maintain the ring clamp in a clamped state and pass it from the right hand to the left. Secure the ring clamp with the left thumb, middle, and ring fingers.

Press the scrotal skin downward with the left index finger while simultaneously elevating the ring clamp with the left thumb, middle, and ring fingers to tighten the skin over the vas deferens. Use one blade of the dissecting clamp to puncture the skin and vas sheath. Then, withdraw the dissecting clamp.

Now, close both blades of the dissecting clamp and reinsert it through the same puncture hole. Gently open the clamp to separate the scrotal skin by about 1 centimeter. Use the right blade of the dissecting clamp to pierce the most superficial and prominent part of the vas deferens wall.

Then, rotate the dissecting clamp 180 degrees laterally and release the extra cutaneous vas deferens fixation ring clamp with the left hand. Elevate the dissecting clamp to extract the right vas deferens from the body. Grasp the delivered vas deferens with the ring clamp using the left hand.

Gently isolate the right vas deferens artery with the dissecting clamp, exposing a clean segment of about 2.5 centimeters. Pull the ring clamp toward the abdominal side and straighten the vas deferens. Use a 3-0 silk suture to complete the first ligation at the testicular end of the vas deferens.

Then, pull the ring clamp toward the testicular side and perform a second ligation on the abdominal side, 1.5 centimeters from the first ligation. Tighten the suture tails of the first ligation toward the testicular side and pull the ring clamp toward the abdominal side. Use the dissecting clamp to clamp the right vas deferens 1 centimeter from the first ligation on the abdominal side.

Release the extra cutaneous vas deferens fixation ring clamp. Complete a third ligation between the dissecting clamp and the first ligation. Rotate the dissecting clamp 180 degrees and pull the tails of the second ligation toward the testicular side, over the dissecting clamp and the first ligation.

Next, using the suture tails from the third ligature, perform a fourth ligation on the abdominal side of the right vas deferens, 1 centimeter from the second ligation. Pull the suture tails of the second ligation toward the testicular side and those of the fourth ligation toward the abdominal side. Perform a fifth ligation between the second and fourth ligations, using the suture tails from the first ligation.

Next, cut off the ends of the three sutures. Pull the right testis toward the testicular side through the scrotum and reposition the right vas deferens with the anatomical reduction in the scrotum. Finally, suture the scrotal incision with 5-0 absorbable sutures.