What happens during a vasectomy?
A vasectomy is a procedure that blocks both sperm ducts, called the vas deferens, which transport the sperm from the epididymis (where the sperm are stored) up through the prostate to the back of the urethra during an ejaculation.
97% of the fluid that comes out during an ejaculation is made in the prostate and seminal vesicles. Only three percent of the fluid comes from the testicle and epididymis, but this contains all of the sperm.
The easiest way of eliminating the sperm but leaving everything else the same is to interrupt the vas deferens. The easiest place to do this is in the scrotum because the vas is directly under the skin.
Innovation: The No Scalpel Vasectomy
This technique was developed in China approximately 20 years ago. In China, men must be sterilized after they father a child in order to qualify for government assistance. This led to a need for a quick and simple method of vasectomy with a short recovery time since almost every man gets sterilized at some point for population control.
Conventional or No Scalpel Vasectomy?
Both procedures are outpatient procedures, performed in the surgeon’s office, using a local anesthetic. But that’s where the similarities end. Compare the details of these two procedures, and you will understand why most men prefer the No-Scalpel method.
|The standard technique for this procedure requires the doctor to make an incision or cut in the scrotal skin.||No cut is made in the scrotal skin. The technique of no-scalpel vasectomy uses a special instrument to grasp the vas through the scrotal skin and hold it in place directly under the skin.|
|The surgeon then must find the vas and surgically separate it from the other structures in the spermatic cord.||Another instrument is used to make a small perforation in the skin over the vas and spread the tissue. The vas is then pulled up and all the tissue around it is cleaned off. This is an important step because all the nerves must be moved away from the vas before it is clipped.|
|The vas is then tied off with sutures, cut and the ends separated.||Once the vas is clear then titanium clips are placed to block the vas. The vas is cut and cauterized between the clips and then separated. A small segment is removed to prevent the vas from growing back together.|
|The skin incision is then stitched back together.||The vas is then placed back into the scrotum and the perforation is sealed without the need for sutures. A bandaid is placed.|
|Procedure takes about 30 minutes.||Procedure takes 10 minutes.|
|Men report more pain and recover less quickly.||Men report less pain and recover more quickly.|
|Complications: 5-10%. Bleeding, scarring, infection. May make reversal difficult should that be wanted in the future.||Complications: Less than 1%. No bleeding or scarring.|
What is a Laser Vasectomy?
Laser energy is very useful for treating kidney stones, skin lesions and certain types of tumors among other conditions. Many surgeons use laser scalpels which cauterize tiny blood vessels as they cut. While laser energy is indispensable in many medical procedures, the nature of laser energy does not provide any advantage over a traditional scalpel vasectomy. In fact, using a laser in any part of a vasectomy could damage delicate tissues since laser energy cannot pass through opaque skin without burning a hole in it. In the future it may be possible to deliver laser energy exactly and directly through the scrotal skin to the vas deferens but to date this option does not exist.
Controlling laser energy during vasectomy
During a vasectomy the vas deferens must be isolated from the muscular sheath surrounding them, nerves must be gently set aside and only then can the tubes be properly severed. Laser energy is not at this time controllable to the fine degree necessary to perform this delicate task. Only a skilled surgeon using specially developed instruments can clear away tissue, nerves and tiny blood vessels from the sperm tubes so that the vasectomy can effectively be done.
A laser can be used to create the incision required to expose the vas deferens and can be used to sever the tubes, but since the tubes must be exposed in some manner a laser vasectomy does not differ from a traditional vasectomy other than in the instrument used to make the incision. In practical terms, using laser technology is expensive and not as effective as the specially designed instruments available for this purpose.
Many men and their surgeons prefer the gentle ‘no scalpel’ method since the tubes are located, prepared and severed with far less trauma to tissue and with far less emotional stress to the patient. Laser vasectomy offers no useful benefit to conventional vasectomy methods either in shortening the time of the procedure or by being less invasive. Whatever method is used, the vas deferens must first be exposed through an opening created by a scalpel, laser energy or pointed forceps specially designed for vasectomy.
Laser vasectomy not considered a beneficial alternative to either traditional or no scalpel vasectomy by the vast majority of urologists. Patients asking about laser vasectomy are mainly unaware of the fact that laser vasectomy still requires an incision into the scrotum.
No needle vasectomy
The least invasive option, and one that has been successfully performed on millions of men, is the no scalpel method. For patients who do not want a needle used in applying anesthetic, there is a less invasive delivery option. In this method anesthetic is delivered to the scrotum using a high pressure spray device that delivers lidocaine anesthetic to the surface and underlying tissues. The no scalpel technique is then performed, taking about 15 minutes and leaving a tiny puncture that doesn’t even require a suture.
Patients who ask about laser vasectomy are almost always under the false impression that this is a completely non invasive technique for isolating the sperm carrying tubes and severing them. Dr. Werthman understands that his patients are looking for the least invasive method for their vasectomy procedure as it involves a highly sensitive area of the body. He is always happy to discuss the pros and cons of traditional or no scalpel vasectomy techniques and to provide information on all aspects of using a laser during vasectomy surgery.