This procedure differs from a traditional vasectomy in that, as its name suggests, it does not require a surgeon to use a scalpel (surgical blade). Instead, they find and clamp the vas deferens from the outside and use a tool that only punctures the scrotal skin.
This article reviews the steps involved in a no-scalpel vasectomy, its advantages and disadvantages, effectiveness, side effects, and more.
No-Scalpel vs. Traditional Vasectomy
The goal of a no-scalpel vasectomy (or keyhole vasectomy) is the same as for a conventional vasectomy—to create a blockage (occlusion) in the vas deferens so that sperm can no longer become part of the semen.
No-scalpel vasectomy is as effective as a traditional vasectomy, but is considered the better surgical approach for several reasons.
During a standard vasectomy, two incisions are made in the scrotum to allow the surgeon to reach each of the vas deferens. However, during a no-scalpel vasectomy, only one small puncture is made.
And because the puncture site is so small, patients usually don’t need stitches, have less pain, and heal more quickly.
Compared to traditional vasectomy, a minimally invasive vasectomy also offers:
Shorter surgery time (about 20 to 25 minutes)Lower risk of infection (due to smaller wound, no long incision)Less chance for bleeding complicationsQuicker recovery with little pain and sooner resumption of normal activities
Minimally invasive vasectomy has been widely accepted as a medical standard for more than a decade. This approach has become far more common than traditional vasectomy.
This is done by:
Cutting off a short piece of the vas deferensRemoving itLigating (tying-off), clipping, or cauterizing (burning) the remaining ends
Some surgeons may take the additional step of fascial interposition, which consists of sewing connective tissue over the free prostatic end of the vas (the end closest to the urethra). This creates a tissue barrier between the vasal ends.
Some research suggests that this additional step decreases failure rates, but the evidence is inconclusive at this time.
Finally, each end of the vas is allowed to slip back into the scrotum.
Open-Ended Procedures
During both traditional and no-scalpel vasectomies, men may be given the choice to have an “open-ended” procedure. This means that only the prostatic end of the vas is tied or cauterized. The testicular end (closest to the testis) is left open.
The reason for keeping this end open is to allow for sperm leakage. Some research has shown that allowing for this leakage prevents the thickening or build-up of sperm because the sperm can flow into and be absorbed by the scrotum. This, in turn, can lead to less pressure—a potential cause of post-vasectomy pain.
The open-ended technique has also been shown to lower complication rates as well as fewer cases of epididymitis (when the epididymis tube at the back of the testicle responsible for storing and carrying sperm becomes inflamed).
Benefits and Disadvantages
Research demonstrates that men who underwent a no-scalpel vasectomy reported:
Overall satisfaction in their sexual livesBeing able to quickly resume having intercoursePositive postoperative psychological statusesNominal postoperative painFew post-procedure complicationsQuick recovery times
However, regardless of how they are performed, vasectomies are still surgical procedures that have some cons worth considering:
Contraception benefit only: Vasectomy offers no protection against sexually transmitted infections or HIV. Lingering sperm: Because sperm may still be present in the vas beyond the point of occlusion, this procedure requires men to use a back-up method of birth control for the first 15 to 20 ejaculations (or about 12 weeks) after the procedure. At your follow-up appointment, your surgeon will check your semen to ensure that no sperm are present. Reversal can be challenging: Though vasectomy reversal procedures are available, they are technically complex, expensive, and have variable success rates.
After Your Vasectomy
Vasectomy is most often an outpatient procedure, which means it’s performed in your surgeon’s office. You’ll go home the same day as your surgery.
Recovering at Home
Most men recover from a vasectomy in about a week. In that time, it’s important to take steps to help your surgical site heal.
Even though you won’t have an incision, you’ll still want to avoid anything that could irritate the area or open the surgical site. That means rest, including no sex, exercise, or heavy lifting.Your surgeon will advise you as to when you can resume your regular activities.
Self-care at home will also include:
Wearing snug underwear or compression shortsApplying an ice pack to the area a few times a dayUsing over-the-counter pain medicine like Tylenol (acetaminophen) as needed
You will also need to watch for signs of infection, such as a fever, and report them to your surgeon if they occur.
Potential Side Effects
Typically, a no-scalpel vasectomy has few major side effects and is only linked to a very small chance of infection and little pain. You may experience a reaction to the local anesthesia.
There is a tiny chance of developing sperm granuloma—a hard, sometimes painful pea-sized lump due to the sperm leaking out from the open-ended vas deferens.
The lump is not dangerous, rarely symptomatic, and is almost always resolved by the body in time. Plus, it may actually serve as a protective feature to the testis and epididymis. The granuloma is rich in epithelial-lined channels that may vent leaking sperm away from the epididymis and protect against increased pressure from sperm blockage.
Costs
In general, vasectomies are considered a lower-cost surgical option. You may be charged for an initial consultation as well as for your follow-up visit to have your semen analyzed. But, after these up-front costs, there are no ongoing costs to maintain this contraceptive method.
This procedure is covered by many private insurance plans. Without insurance, depending on your geographical location and the facility you choose to use, a no-scalpel vasectomy will typically cost between $500 to $1,000 (some facilities will bundle all of your visits into one price while others may charge for each individually).
Effectiveness
The no-scalpel vasectomy is extremely effective— approximately 99.7% effective, but this is based on the man using back-up birth control until he has been cleared by the doctor that there is no sperm left in his semen.
Of special note, the no-scalpel vasectomy is not 100% guaranteed to be effective. Even when the procedure is performed perfectly, the possibility of recanalization can occur. This is when sperm manage to find their way across the blocked ends of the vas deferens. The possibility of this occurring is very rare (well below .5% of the time).
This is why it is extremely critical that you undergo your semen analyses 6-12 weeks post-vasectomy to be absolutely sure that no sperm are present.
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