This is the earliest form of vasectomy as such. The surgeon will usually make 2 incisions over the area, where he / she expects the vas to sit. The vas will then be interrupted. A variable amount of vas may be removed (or not) and more often than not a tie will be used to close the ends on both sides of the vas. Finally the scrotal skin is approximated, usually using (non) absorbable suture material.

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This technique was first developed in China in the 70ies, but the real breakthrough began, when the Americans started to promote it heavily in the 90ies.

The major difference to conventional vasectomy is in the way the doctor gets to the tubes. The tubes are secured externally with an instrument and the surgeon will almost always only use 1 very small incision to get to both tubes.

The name "No-Scalpel" however originates in the second difference of this technique: A special instrument is used to create a pinpoint opening in the centre of the scrotum and to separate the scrotal skin. This gives enough space to extract both tubes. However the more "natural" opening is thought to allow the scrotal skin to heal without stitches.

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Alternative Interruption:

Initially the vas was interrupted and tied. Over the years surgeons tried to reduce vasectomy failure rates. This led most surgeons to remove a variable amount of the vas before tying both ends.How much of the vas needs to be removed remains a puzzle as medical research has not been able to answer this question satisfactorily.

Most No-Scalpel Vasectomists, but also an increasing number of doctors employing the conventional method have started to use different equipment to interrupt the tubes.

Nowadays, many use electrosurgical equipment (i.e. a hyfrecator) to cauterise rather than remove the vas up to a certain length. A fair number of doctors leave the ends of the vas open, because there is good evidence, that this technique does not have a higher failure rate. On the contrary it is felt, that it causes less pain afterwards if the distal end is left open.

Clips have come out of fashion until recently, when the so called "vasclip" was approved by the FDA and introduced to the US market. In the past research has shown clips to have inferior success rates and new guidelines by the Royal College of Obstetrics and Gynaecology (currently available as Draft Version only) advise to refrain from using clips.

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Vasclip is a new plastic clip. Its makers feel it makes vasectomies reversable as no tube is removed during the operation. FDA approval has been granted on a study of only 200 participants.

It is to early to judge whether or not vasclip has any real advantages. It is unlikely that patients will only need to remove the clips to be fertile again. I feel it is highly likely, that a full reversal procedure will have to be performed for most. I also fear failure rates may be similarly inferior as with conventional metal clips.

The initial study only showed rates of infertility after the procedure, but not any rates of fertility after reversal.

When compared with conventional metal clips vasclip has the potential advantage of MRT compatibility (i.e. patients can have an MRT / MRI scan with vasclip). Of course MRT compatibility is given with any vasectomy not using metal clips.

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This is a new technique currently developed, which may allow in the future to do a vasectomy without incision by applying ultrasound waves from the outside to the vas. However, this technique has not proceeded beyond animal testing yet and it may be some time until it can be employed on humans if proven successful.

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The idea behind this is to implant a microtap into both tubes to allow to switch sperm supply on and off. Again, this technology is currently in the animal testing phase. Whether or not this will be a viable option for the future remains to be shown.

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