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A Vasectomy in Pictures
At the beginning of the vasectomy and after the sterile prep and drape, an area has been marked to show the penoscrotal junction at the mid line of the scrotum (the median raphe). It is here and through this single grain of rice sized opening will be made with the no scalpel instrument.
In the No needle No scalpel vasectomy technique the Madajet injector uses pressurized energy to anesthetize vas tube without having to use a needle.
The no scalpel sharp pointed hemostat is then used to puncture the skin and spread minimally to make an opening in the scrotal skin.
As noted above the three finger technique of using the thumb and index finger to isolate the vas and bring it to the skin. Here the sharp pointed hemostat is being used to make the small opening through which both vas deferens will be treated.
The cantilevered vas grasper is then used to insert through the opening and grasp the vas and bring it to the surface.
As seen above the vas on the right side has been grasped and brought to the surface to begin the process of severing and destroying the two ends of the vas deferens.
The sheaths that surround the vas tube is then separated from the inner lumen of the vas and this is then isolated and further brought into the operative field. The inner portion of the vas is now seen and the surrounding sheaths and small blood vessels have now retracted back into the scrotum and away from the tube that will be severed.
The connective tissue and small blood vessels are now separated from the actual vas tube using the sharp hemostat. The vas is now prepared to be cut in two, remove a segment and the ends destroyed.
A hemostat has been placed at the base of each limb of the vas in preparation of cutting out a segment before the fulguration of each end.
There is now as segment of vas removed and electrocautery is used to heat and destroy the lumen of each side of the remaining vas deferens. Of note there are several methods used to destroy the remaining ends of the vas. All are equally effective and usually the method chosen is at the discretion of the surgeon.
In the above picture one sees the treated two ends of the severed vas and the charred end of each segment.
As the hemostats are removed the vas and the incision are inspected for bleeding. As you can see the ends are free of any bleeding and are barely extruding through the small opening that has been made. Having noted no bleeding the ends are then allowed to retract into the scrotum.
The instrument is pointing to the opening and you can see it is very small, dry of blood, and will not require any sutures. The other side of the procedure will be done in a similar fashion and through the same small opening.
This procedure was done at the Northeast Georgia Urological Surgery Center took less than 15 minutes.
Dr. McHugh in his career has performed several thousand vasectomies.The procedure rarely takes more than 15 minutes.No skin sutures are needed.The No Scalpel technique is done quicker and minimizes pain and swelling.Patients are advised to be off their feet for a couple of days and use scrotal compression shorts.No sexual activity for one week.No unprotected sexual activity until no sperm are seen in the ejaculate in two specimens at 6 and 8 weeks or a negative spermcheck.com test kit.
Vasectomy in pictures-“The movie.” Click the YouTube play button. (Over two thousand views!)
And of course the procedure should only be performed if the couple has thoughtfully considered all options, consequences and consider the procedure permanent. However…Dr. McHugh commonly performs Microscopic Vasectomy Reversals and is one of Georgia’s most experienced urological microscopic surgeons.
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