|Vol. 25, No. 10||June 1, 2003|
No Scalpels, No Sutures, No Excuses
By DAVID THEIS
The University of Texas
Health Science Center at Houston
At age 35, Harold Hardeman is living the good life. With a loving wife, a promising career, and two beautiful daughters, he couldn’t ask for more ... in fact, he doesn’t want more. More kids, that is.
“My little girls are the best in the world ... I like life just the way it is,” he says, drawing 6-year-old Sa’Quyia and 3-year-old Shayla close.
When he talks about the future, Harold’s excitement is evident. He and wife Georgia are both medical assistants, and plan to return to school to obtain nursing degrees. With their daughters well past diaper days, family vacations are beckoning Disney World for the girls, a Caribbean cruise for the grown-ups.
“Can you imagine if we got pregnant again? All our plans, all our hopes would be wiped out ... not to mention our bank account. It’s expensive raising a child!” Harold says.
That’s why he, with Georgia’s full support, decided to undergo a vasectomy ... but not just any vasectomy.
Squeamish at the thought of knives, needles, and anybody cutting “down there,” Harold opted for a newer vasectomy technique, which, unlike the conventional method, involves no scalpels, no stitching, no sweat. Developed by Chinese surgeon Dr. Li Shunqiang in 1974 and commonly practiced in the United States since 1988, the technique is rapidly gaining popularity throughout the world.
In a no-scalpel vasectomy, the doctor feels under the skin of the scrotum to locate the vas deferens (the tubes through which sperm pass into the semen). The vas are then held in place with a small clamp. Next, a special instrument is used to make a tiny puncture in the skin and stretch the opening so the vas can be cut and tied. This approach produces very little bleeding, and no stitches are needed to close the punctures, which heal quickly by themselves. The newer method also causes less pain and fewer complications than conventional vasectomy.
But the good news is that vasectomies no longer require much cutting. With the “scalpel-less vasectomy” procedure, the process has become more of a pinch than a slash.
In the right hands, such as those of Grant Fowler, M.D., professor and vice chair of the department of family practice and community medicine at The University of Texas Medical School at Houston, the procedure is usually completed in about 15 to 30 minutes.
Fowler schedules vasectomies on Fridays, and says that afterward his patients just “need to take the weekend off and keep their feet up.” In fact, the procedure is so mild that “I’ve had people go back to work the day of surgery,” says Fowler (though he doesn’t recommend it, since jiggling can lead to scarring and scarring just leads to natural reversal known as failure.)
Fowler and his UT-Houston colleagues, Carlos Moreno, M.D., chairman of the department, and Carlos Dumas, M.D., actually deviate somewhat from the procedures established by Li almost 30 years ago. After numbing the area, Li made a small puncture into the scrotum with a tiny hemostat, gently lifted out the vas deferens, removed a portion of it, cauterized it, and then placed the severed tube back into place.
The UT-Houston doctors, on the other hand, first anesthetize the area, and then, in fact, do use a scalpel to begin the procedure, just because it works more efficiently. (Fowler suggests changing the name of the procedure from “scalpel-less vasectomy” to “minimally invasive vasectomy.”)
Next, using the clamp that Li developed, they pull out the tube, remove about a 1-inch section, and interpose a plane of fascia between the cut ends. The tubes and tissue are then clipped, and closed with one or two titanium clips (hemoclips). Titanium is preferred since “they don’t set off metal detectors and are MRI-proof,” Fowler says.
Hemoclips also speed up the procedure.
“We used to double-tie both ends. That’s eight knots and two clips,” he adds.
The newer way of performing a vasectomy helps prevent blood flow constriction which causes scarring.
“The body is a miraculous thing once you get scarring, the ends can open up again and recommunicate not exactly the result you’re looking for in this case.”
Just to be on the safe side, Fowler also cauterizes the ends.
“Then you just drop the vas back in and you’re done,” Fowler says.
The puncture is so small that sutures are usually not necessary.
“It’s a very elegant procedure,” Fowler says.
Afterward, patients are sent home for their “feet-up” time. Fowler typically prescribes one of the new non-steroidal anti-inflammatories for pain control, an hour before the procedure. Usually the single dose will cover the patient about 18 hours, which in most cases, is enough.
After the procedure, patients can actually drive themselves home, but it is not recommended.
Life goes back to normal almost right away.
“I tell my patients that they can have sex whenever they feel like it,” Fowler says.
As with the original vasectomy, however, the minimally invasive procedure leaves patients with “bullets in the gun” for about six weeks. Fowler suggests having 21 ejaculations before sounding the “all’s clear.” Patients should have a sample checked at that time to make sure they really are no longer fertile.
The procedure is more effective in terms of preventing pregnancy than the female option of surgical birth control tubal ligation and far safer to perform. Fowler has had only one failure in 11 years of performing the procedure, while tubal ligation fails about one time in 300.
The minimally invasive vasectomy can be reversed as easily as the old-style procedure, although all vasectomies should be considered permanent. There is no hormonal fallout, and studies show that sexual activity goes up after the procedure.
Interestingly, the morbidity/mortality rate of this procedure is nil everywhere but in India (from tetanus), Fowler says, because it is so often performed in the marketplace.
Though urologists have been the main providers through the years, they often are busy with much larger surgical cases. Since vasectomy is almost always considered an in-office procedure, more and more non-surgical practitioners are offering vasectomy.
Reprinted in part from
“UT HealthLeader,” available at http://www.healthleader.uthouston.edu
©2006 Texas Medical Center