A traditional vasectomy involves a double incision of the scrotal wall and complete exposure of the vas deferens so that it can be severed and sealed. Once the ducts have been sectioned, according to the traditional technique, both ends are closed, both the one coming from the testicle and the one going up towards the seminal vesicles.
The no-scalpel technique, on the other hand, is performed with a cute opening of approximately 5 mm in the middle of the scrotum. Through this small opening, the ducts are reached and externalized by means of a microsurgical instrument. The “open ended” variant consists of sealing only the extremity of the vas deferens leading upwards, leaving open the stump coming from the testicle. This measure avoids congestion of the semen and reduces postoperative pain since the vas deferens closes physiologically and gradually in the weeks following the operation. To avoid the risk of spontaneous recanalization, the open end is secured outside the fascia that naturally surrounds the vas deferens, with an internal absorbable suture.
Dr. Nicola Tartaglia, Urologist, Andrologist and expert in Sexual Medicine and Fertility, is committed to this procedure, which almost all patients describe as more “bearable”. For this, the doctor resorts to local anesthesia, unless the patient’s clinical conditions do not require sedation or general anesthesia. As it is a mini-invasive technique and of short duration (25 – 35 minutes), the anesthesia is applied with an insulin needle, which is practically unnoticed and it is possible to start without the patient noticing any pain.
In addition, during the procedure it is possible to add more anesthetic as needed, just as the dentist does during a tooth extraction.
Who is a good candidate?
In general, all men can receive a no-scalpel vasectomy, although in patients with previous testicular surgery or inguinal hernioplasty it can sometimes be difficult to externalize the vas deferens and the traditional technique must be used. Likewise, there are some cases in which it is decided not to perform the “open ended” variant due to the limited length of the vas deferens (men with high testicles, attached to the root of the penis). The preoperative assessment is a necessary act to foresee these situations and in my practice I always perform a testicular ultrasound prior to surgery to have a clear picture of what I am going to have in front of me.
Benefits for the patient’s sexual health
The externalization of the deferens makes it possible to work without opening the scrotum, which reduces the risk of testicular infections, the risk of intraoperative and postoperative bleeding and speeds up recovery. The “open ended” variant also reduces pain due to sperm congestion in the first weeks after surgery. In fact, the testicle does not stop semen production, it simply slows down over time. Studies report that the deferens left open heals and closes spontaneously within 3 months allowing the process to generate less pain than in the traditional technique.
The “open ended” no-scalpel vasectomy is reversible, just like the traditional one, but in this case the success of the procedure depends, above all, on the time that has passed since the vasectomy rather than on the type of technique. A man who had the procedure 5 years ago, for example, is much more likely to have the reversal work than a man who had the vasectomy 15 years ago, and this is due to internal scarring and retraction of the vas deferens.