A vasectomy is performed with the aim of preventing the passage of sperm along the spermatic cord. This is done by picking up the vas which is located just under the scrotal skin, and cutting the tube. In some cases the ends are left open but in most the ends are tied with surgical stitchs and the ends sealed with heat which studies show increases effectiveness. The 2 new ends are then positioned away from each other and a small piece of tissue positioned over one of the ends to discourage rejoining. This is called fascial apposition. After the procedure the vas is then released into the scrotum.
It is quite confusing when looking at the information available relating to vasectomy methods but in summary occluding and sealing the ends (dividing, tying off and diathermy) is the most effective approach. Leaving the ends loose may reduce the chances of a collection of sperm forming at about 4 weeks. Scalpel free vasectomy is really the same as conventional vasectomy except that an instrument is used that makes 2 small holes at the site of the vas which are smaller than some conventional incisions.
Scrotal skin heals very well as it is the only skin on the body that does not pull apart during healing. This is why stitches are not needed on the skin layer. At Sydney Vasectomy Clinic we feel that the procedure should be extremely effective at providing permanent contraception, with short term effect on general well being and sexual function. We therefore do vasectomies through a single very small midline incision (about 0.5cm) close to the embryological scar tissue. We operate on one vas at a time by ligating (tying), dividing (cutting), and applying diathermy (sealing) the 2 new ends. These ends are then separated by fascial apposition to reduce the chance of vasectomy failure.
All men undergoing vasectomy will have local anaesthetic into the midline of the scrotal skin and into the vas on either side. This stings initially for about 5 seconds before the area goes numb. We offer intravenous sedation for vasectomy. This is recommended to provide general relaxation , sleep, and also loosening of the scrotal skin which means that the procedure is easier.