Laser Vasectomy, Scalpel Vasectomy and No-Needle Vasectomy Procedures
Vasectomy Procedure History
The scalpel vasectomy was the first technique used 100 years ago. It began as a serious surgical procedure in which instruments designed for use on other parts of the body, including using a surgical scalpel, were “borrowed” for a vasectomy. It involved two surgical incisions, one on each side of the scrotum, through which access to the sperm conducting tubes (the vas deferens) on either side of the scrotum was obtained. And as a surgical procedure, it has worked exceptionally well and has stood up well to the test of time, sporting a failure rate of <1/1000 in the best of hands.
However, about 30 years ago, starting in China, the standard surgical scalpel vasectomy underwent its most significant evolution to date: it was modified to eliminate the need for an incision through the development of instruments that were especially designed for the vasectomy procedure. These instruments improved the efficiency of finding the sperm tubes and, as a result, have decreased procedure time, healing time, degree of swelling and need for pain pills afterwards. It has not, however, improved the overall success rate of the procedure as the method of blocking the sperm tubes remains unchanged and is surgeon-dependent. Throughout its history, then, the vasectomy has continued to be the single most effective contraception available. Through its evolution, it has become a more acceptable procedure for more men.
To learn more about the different types of vasectomy, please select one of the following topics. To Learn more about Dr. Turek’s preferred method, please go to No-Scalpel Vasectomy.
The Laser Vasectomy
Among the advances in vasectomy technique over the past 20 years, the idea of laser vasectomy is NOT one of them. Now don’t get me wrong, I love lasers. I have written papers (Turek et al. KTP-532 Laser Ablation of Urethral Strictures. Urology, 40 (3): 330-334, 1992) and chapters on them and I am a fully certified laser urologist. However, a vasectomy is not like a kidney stone, an enlarged prostate or a urethral stricture, all of which are all well suited for the destructive power of lasers. The simple fact is that, besides adding expense, laser technology is overkill and does not make the vasectomy either a quicker (now 10-15 minutes) or better (now fewer than 0.1% fail) procedure than it is already. In addition, it does not offer increased reversibility that could improve its position as a contender to the no-scalpel method. Lasers could have a future in vasectomy when it allows for a “no-touch” approach that would avoid both local anesthesia and surgical manipulation of the scrotum. Believe me, when this arrives, I will be an early adopter of this method!
The Scalpel Vasectomy
The vasectomy is an entirely American invention and is about 100 years old. It began as a serious surgical procedure in which instruments designed for use on other parts of the body, including using a surgical scalpel, were “borrowed” for a vasectomy. It involved two surgical incisions, one on each side of the scrotum, through which access to the sperm conducting tubes (the vas deferens) on either side of the scrotum was obtained. And as a surgical procedure, it has worked exceptionally well and has stood up well to the test of time, sporting a failure rate of <1/1000 in the best of hands.
The No-Needle Vasectomy
Recently, there have been claims that a “no needle” vasectomy is better than any other kind. Before taking this as truth, realize that the success of the vasectomy procedure as a contraceptive technique has not improved since it was developed 100 years ago. This is because the method of blocking the tubes (vas deferens) that conduct sperm has remained unchanged over the history of the technique. What has changed is the way that the scrotal skin is numbed for the procedure and this is why the “no needle” approach is considered new. Instead of using a fine needle to numb the scrotal skin and underlying sperm tubes, the “no needle” approach employs an old-fashioned, compressed air, mechanical vaccine gun to force the local anesthesia through the scrotal skin. This is the exact same approach used to give mass vaccinations for small pox a generation or two ago, the one that left the dime-sized scar that you may have noticed on your own, your parents’ or your grandparents’ shoulder. What I have found using this technique is that the “gun-like” sound that the device makes when fired tends to offset the calm, relaxed and tranquil mood that I try to create for the procedure. This in turn makes many men edgy and nervous just when I don’t want them to be. Because of this, I have developed an alternative “minimal touch” technique that conveniently avoids both the noise of the vaccine gun and most of the sting of the needle approach.
To learn more about Dr. Turek’s preferred method, please go to No-Scalpel Vasectomy.