According to data generated by the National Survey of Family Growth, an estimated 175,000-354,000 vasectomies were performed annually from 1998-2002. If you’re considering the procedure, you may want to explore a newer technique that involves no needles, no scalpel, and no stitches. Dr. Andre Gilbert, member of the Board of Directors at the Findlay Surgery Center and former president of the Ohio Urological Society, answers questions about the No-Needle/No-Scalpel vasectomy procedure.
HealthScene Ohio: How new is the no-needle/no-scalpel vasectomy procedure?
Dr. Andre Gilbert: I would say it’s been more than 15 years. I’ve been doing it here in Findlay for at least 10 years.
HSO: What were some of the more traditional approaches to this procedure?
AG: Well, the name says it. The difference with the no-needle is that I don’t use a needle to deploy the local anesthetic. We use a device that under pressure deploys the local anesthetic through the skin as well as numbing the vas deferens, the little tube that the sperm travels through in which we are aiming to intervene and interrupt that flow. By using this device, we don’t have to use a needle, which is something that a lot of patients appreciate. Instead of a scalpel, we use small, pointy forceps that makes a small opening on the skin after the skin is numbed.
HSO: Can you briefly describe how the procedure is performed?
AG: The opening in the skin is approximately one-quarter of an inch, and through that opening, we are able to identify and isolate the vas deferens. There are different ways to interrupt the flow of the sperm, some people just put a tie on the tube, I actually excise a segment of the tube. I use a cautery to burn the tube at both ends after I remove the segment. That’s a way to impede the sperm’s ability to travel. I use a small titanium clip at both ends of the tube and then when I put that back in the patient’s body, I put some soft tissue at both ends. By doing that, I increase the chance of preventing a vasectomy from failing. If you think of a hose, if you remove a segment, now you have two pieces of the hose, they are no longer connected. The procedure takes about 10 minutes, give or take.
HSO: What is the average recovery time? Are there any post-op limitations?
AG: A lot of people are concerned about how much time off work they’re going to have to take. We recommend to rest the following day and then they can go back to work the next day if they have a desk job. Now, if you work in the factory line and you do a lot of heavy lifting, we recommend to be on light duty for a week and then resume whatever you do. You have to be prudent and use common sense.
HSO: What are efficacy rates of this procedure compared to with traditional ones?
AG: I’ve personally never seen a vasectomy fail. Failure can occur due to events such as technical errors or unprotected intercourse before azoospermia(sperm-less semen) is documented. Every surgeon has their technique once they get the vas deferens and what they’re going to do. But bottom line: doing no-needle will maintain the efficacy of the procedure. Even though the risk is always there, it’s minimal.
HSO: Why do some men choose to have this type of vasectomy over the traditional method?
AG: It’s less traumatic and because of that there is less discomfort, less pain and faster recovery time. I’m surprised that more people don’t do it.
HSO: What are some short- and long-term complications associated with vasectomies in general?
AG: The routine complications that you can have with any procedure like infection, pain and more swelling. Other than that, some people can have pain linger a little longer on the scrotum but that’s pretty rare.
HSO: How common is it for men to have their vasectomy reversed?
AG: That’s the reason why I meet them beforehand because I want to make sure that they decided at the right time to have this done. But if I see a mature person with a wife and kids and established family, that’s fine. Most people that have regrets about doing this have initiated a second family: they got divorced and remarried and want to have kids again.
Additional Information
The varying techniques employed in vasectomy to fulgurate, ligate, and manage the vasal ends are associated with different failure rates. Representative failure rates are listed below
- Cautery (both ends) and fascial interruption: 1.2 percent or less
- Cautery (prostatic end only) and fascial interruption (clip): 0.02 to 2.4 percent
- Cautery of both ends and excision of a segment: 4.8 percent or less
- Ligation and fascial interruption: 16.7 percent or less
- Ligation and excision of segment: 1.5 to 29 percent
- Intraluminal needle cautery (vas not transected, no segment removed, rarely performed in North America): Less than 1 percent
Recanalization is rare, occurring in approximately 0.2 percent of patients. It is defined as the presence of any spermatozoa after one or more previously azoospermic samples were properly collected and documents. It can occur at any time following vasectomy.
Evan Wehmeyer is a contributing writer. Feedback welcome at feedback@cityscenemediagroup.com.
About the Expert
Dr. Andre Gilbert graduated in 1981 from the Medical School at Faculty of Medicine from ABC Foundation in Sao Paulo, Brazil and received his Master’s Degree in Urology from the Paulista Medical School in 1988. He completed his urology residency at the University of Cincinnati Medical Center in 1998 and has been practicing in Ohio ever since. He currently works at Blanchard Valley Urology Associates located in Findlay.
