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  • Title: Vas deferens occlusion during no-scalpel vasectomy.
    Author: Reynolds RD.
    Journal: J Fam Pract; 1994 Dec; 39(6):577-82. PubMed ID: 7798862.
    Abstract:
    The increasing popularity of the no-scalpel vasectomy (NSV) technique in the United States is driven by patient demand for surgical procedures presumed to be less invasive and by the somewhat lower complication rate of the NSV technique. The NSV technique addresses vasal delivery but not vasal occlusion. Intraluminal red-hot wire cautery with sheath closure over the inguinal end of the cut vas (Schmidt's method) has the lowest failure rate of all reasonable vas occlusion methods. The anatomical relationships of scrotal layers can be unclear during the NSV technique. Accurate identification of the sheath layer is critical to sheath interruption if this method of occlusion is to be used. Placement of an absorbable purse-string suture for sheath interruption during the NSV procedure is described. Special attention must be given to placement of one suture bite in the deep (posterior) sheath wall. The vasal occlusion technique described in this paper blends a refined method of vasal delivery (NSV) with the most effective method of vasal occlusion (cautery with sheath interruption). The no-scalpel vasectomy (NSV) technique guides clinicians in delivering a loop of the vas deferens outside the scrotal skin but does not address vas occlusion. An uninterrupted sheath, which surrounds the vas deferens, can lead to recanalization. An Ohio-based family practitioner outlines the operative technique for sheath interruption and intraluminal red-hot wire cautery of the inguinal end of the cut vas (Schmidt's method). After delivering the loop of the vas deferens through a skin puncture using the NSV technique, the clinician should identify the sheath layer and then use the NSV dissecting forceps to dissect it in the inguinal direction. Two straight extra-delicate mosquito hemostats should grasp the sheath layer at the 10 and 2 o'clock positions. The clinician then should use an extra-delicate curved mosquito hemostat to bluntly dissect around the vas, opening the tissue plan between the bare vas and the initially deepest side of the still-adherent sheath. Using a curving open-close motion, closed hemostat tips are used to bluntly dissect along the vas-sheath plan. Next, the tips are opened widely to strip the sheath off the vas. The clinician then uses a small taper-point needle to perform the purse-string suture to close the sheath. Blunt-tipped Steven's tenotomy scissors are used to hemi-transect the vas to the testicular and inguinal side of the curved mosquito hemostat holding the apex of the loop. The clinician then applies 5 mm of intraluminal hot cautery to each hemi-transection site. He/she must then place the third suture bite in the posterior sheath to properly close the sheath over the inguinal end of the vas and destroy sheath continuity. After removal of the straight mosquito hemostats from the anterior sheath, the clinician ties and tags the purse-string suture. At this point, he/she should complete the vasectomy accordingly.
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