Is the No Scalpel Vasectomy a gimmick? Yes and No.

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The very first vasectomy ever performed probably isolated the vas deferens, cut out a section and then destroyed the cut ends. This has the effect of a double whammy to assure sterility. How the ends are destroyed or closed is myriad-clips, suture, fulguration, folding the vas on itself and tying- doesn’t really matter in terms of the long-term success rates.

When I learned to do a vasectomy as a resident in the 1980’s, we made a fourth of an inch midline scrotal incision and brought the vas to the surface with a instrument called a towel clip. It had two fine pointed ends and was used to hold towels in place to isolate the surgical field. This instrument was adapted to many functions in surgery and in urology was the device of choice for a vasectomy.

The China Method or the No scalpel method introduced two instruments. One is the fine pointed hemostat which is used to spread the skin for the vasectomy opening. (So there is still an opening but you did not use a scalpel to make it-whoopee do.)

The fine pointed hemostat is also used to open the vas sheathing without having to incise it with a knife once the vas has been isolated and brought to the skin.

This is where the grasper is used. The opening is smaller-a grain of rice in length- and the grasper allows for the urologist to easily grasp and bring the vas to the skin to perform the procedure.

The story line goes that the procedure has a smaller opening, that the opening heals better because the skin has been spread and not cut, the procedure can be done quicker  because of these instruments, and that the patients do better with less heal time and fewer complications.

So is it a gimmick? Well it is a better procedure now because of these instruments, but we still identify, cut and destroy. You can decide if all this fuss in nomenclature warrants “spreading” is better than “cutting” an opening that is less than a centimeter in length.

No Scalpel does have a ring to it I must admit. The No Needle vasectomy is another story; I’ll do that at another time.

Of note, these same two instruments are also very useful in preparing the post vasectomy vas for the microscopic vasectomy reversal.

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