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    Vasectomy: A different approach to isolating the vas

    Daniel H. Williams, IV, MDDaniel H. Williams, IV, MD Cigdem Tanrikut, MDCommentary by Cigdem Tanrikut, MD

    Dr. Williams is associate professor of urology, obstetrics and gynecology, residency program director, and director of male reproductive medicine and microsurgery at the University of Wisconsin School of Medicine and Public Health, Madison.

     

    Section Editor’s note: ‘Y’tube, a new video section of UrologyTimes.com, is a resource for urologists and other clinicians who focus on men’s health. ‘Y’tube covers surgical aspects of a variety of men’s health issues with the ultimate goal of accumulating a library of videos to serve as a reference. In this installment, urologists demonstrate key elements of no-scalpel vasectomy techniques. 

    This video demonstrates the steps of a minimally invasive, no-scalpel vasectomy technique using titanium hemoclips and electrocautery. Once exposed, the vassal sheath is opened with a #15 blade. Fascial interposition was not performed in this particular case. Skin sutures are not typically needed. Only one side of this bilateral procedure is shown.

    Dr. Tanrikut: Dr. Williams’ video demonstrates an alternative approach to initiate the no-scalpel vasectomy that may be particularly useful in patients with a tight, contracted scrotum or thickened scrotal skin. Rather than fixating the ring clamp over the vas deferens and overlying skin, he maintains the three-finger technique fixation of the vas while puncturing the skin using the sharpened hemostat, then dissecting down to the level of the vas. Once percutaneous access has been gained, he is able to secure the vas within its sheath using the ring clamp and deliver it into the wound in order to proceed with the remainder of the procedure.

    Dr. Hotaling: Vasectomy is one of the most commonly performed (and litigated) procedures in urology. It is estimated that roughly 500,000 men undergo vasectomy each year. These videos by Dr. Goldstein/Li and Dr. Williams illustrate the crucial parts of this procedure. As a center that, much like Dr. Williams, performs many microsurgical cord denervations for post-vasectomy pain, we have come to believe that one of the key components necessary to avoid this is strict isolation of only the vasal segment without any surrounding tissue.

    Dr. Williams’ video illustrates the principles of fascial interposition and a different approach to isolating the vas, using a jake to develop space on either side of it and grasping it with a vas clamp. This is our preferred technique at The University of Utah Center for Reconstructive Urology and Mens Health. Dr. Williams also uses a piece of gauze to bluntly clear off the vas, followed by sharp dissection of the peri-vasal tissue. Dr. Williams also illustrates how the clips can be easily used to perform fascial interposition, the AUA guideline-recommended method of vasectomy.

    James M. Hotaling, MD, MSSection Editor James M. Hotaling, MD, MS

    Dr. Hotaling is assistant professor of surgery (urology) at the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City.


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