A minimally invasive vasectomy with the no suture, inline method for vas occlusion.
OBJECTIVE: The current vasectomy methods, including the no scalpel vasectomy (NSV), have received considerable attention in recent years, because they are minimally invasive and utilize special instruments to expose the vas. However, at least 28 different methods for vas occlusion have been utilized with these procedures, and some postoperative complications have been attributed to the method of vas occlusion. Therefore, in this report we will critique the existing methods for vas occlusion and introduce a new and rapid method. PATIENTS AND METHODS: The NSV instruments were used to expose the vas, but, in addition, a fine skin hook, a short-bladed tenotomy scissors, and a hand-held, hotwire cautery were used for the new no suture, inline method of vas occlusion. No ligatures were placed around the vas, no portion of the vas was removed, and the mesentery behind the vas was not disturbed. The vas sheath was disrupted, there was luminal cautery on both the abdominal and testicular sides, a section of vas was detubularized and trimmed, and its epithelium was destroyed by cautery. This technique has been performed in 158 consecutive cases. RESULTS: All patients have demonstrated complete azoospermia on two follow-up semen analyses, with no pregnancies reported. CONCLUSION: This new method of vas occlusion seems to be rapid and compatible with the NSV instruments.