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Vasectomy: A New Approach It is well over thirty years ago now since I carried out my first vasectomy procedure. I was working as a General Practitioner in rural Ontario at the time. My tutor was a fellow GP and the patient was under general anaesthetic, which was just as well! Vasectomy is technically a very difficult procedure to learn how to do. It is only after some one hundred procedures or more that one starts to feel confident. In 1974 I returned to Ireland having spent almost six years in Canada. By that stage I had acquired sufficient skill as a vasectomist to be able to offer my services to the then fledging Irish Family Planning Association. And they were only too glad to take me on because at that time there was not one doctor in Ireland who had ever performed as much a one single vasectomy! Unwittingly I had landed on my feet. It was your classic win win situation. In time, I parted company with the Family Planning Association but not before serving as their Chairman for three years. I continued doing vasectomies of course as I do to this day. To date I have some thirty thousand vasectomies to my name. Not that this allows for any complacency mind you. No, each operation still must be approached as a new individual challenge requiring absolute concentration and attention. It will be ever so. Over the years, vasectomy techniques have gradually changed of course, not just for me but also for all doctors involved in the procedure. In 1974 a Dr Shunqiang Li introduced the so-called ‘No scalpel’ approach to vasectomy in China. Ten years later, this method of vasectomy had spread to the US and Canada. Claims are sometimes made that this No Scalpel approach to vasectomy gives rise to less complications. However, in fact there are no sound scientific studies to substantiate any such claims. ‘No Scalpel’ vasectomy is a perfectly legitimate approach to the operation and it is not my intention here to in any way attempt to decry it. However, it need to be pointed out that when Dr Li devised this technique in China he did so as a devise, as much as anything else, to make vasectomy seem less invasive in order to attract more clientele. For China, as we all know, has a massive over-population problem. Complications from vasectomy such as haematoma and infection, have in fact little to do with technique used but all to do with the surgeon’s skill and the setting where the operation takes place; an office setting being ideal. Studies attempting to prove the superiority of No Scalpel vasectomy are usually not comparing like with like with cohort groups and therefore their results must be questioned. However, this is very important: You may have heard of ‘open-ended vasectomy’? Open-ended vasectomy is where the testicular end of the cut vas is left open and not cauterized or sutured or clipped or bent back on itself in any way. Leaving the testicular end open allow for the sperm to continue to flow and fall into the scrotum and not build up into a “sperm granuloma” that can give rise to lifelong chronic pain afterwards. I do not wish to get too technical here, but the other thing that is important, if you are considering a vasectomy, is a technique referred to as ‘fascial interpositioning’. Here the abdominal end of the cut vas is crushed and tucked away in a separate anatomical compartment known as the fascial sheath. Doing this greatly reduced the incidence of vas failure or breakdown later. In 2005 I attended a conference on Vasectomy in India where a paper was presented on the use of titanium clip to achieve fascial interpositioning. So impressed was I by the presentation that, on my return from India, I equipped myself with clips and applicator. Last year I published a study comparing my pre-India and post-India vasectomy results. This showed a significant reduction in all complications, including vasectomy failure, with the used of facial interpositioning using titanium clip. Today I use no sutures inside or outside of the scrotum. I have also given up using cautary and crush the abdominal end of the cut vas instead. I achieve fascial interpositioning using a tiny titanium clip. All of these changes have made my life, and I hope the life of my clients, a great deal easier.
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