No-Scalpel Vasectomy

 

Vasectomy used to be done via two incisions on the upper lateral scrotum. Nowadays many, if not most, are performed through one opening centrally below shaft of the penis in the upper scrotum.  This is referred to as the no-scalpel technique, as the skin is usually punctured with a sharp forceps, then torn open, causing a ragged but non-bleeding wound, instead of being cut with a sharp blade, causing bleeding that seems to go on and on.


This technique demands 2 special instruments. Firstly a sharp pointed curved forceps, sharp enough to pierce the skin, and secondly a tissue-grasping forceps that does cause (much) damage the vas deference or skin. Below I explain how to get these instruments at minimal cost.


To summarize, the Vas is moved with the fingers till it is centrally below in the upper scrotum. The tissue-grasping forceps is used to grip around the Vas together with overlying skin and lift it, and the sharp forceps is forced through the skin and opened up to tear the over-lying skin. The Vas thus exposed is stripped of surrounding fascia, and cut and tied as per usual method. 
The other Vas is then moved under the hole, and grabbed through the same hole and cut and tied after stripping off all the overlying vessels and fascia. The hole in the scrotum does not require suturing.


The point of the story here is that companies sell the 2 instruments for a prodigious sum of money far in excess of the cost of other medical instruments. I have made several sets of these instruments myself at a negligible cost, and so can you.


For the Sharp pointed forceps used to pierce the skin and rip the hole in the scrotum, there are 2 options. What I did was to take a curved mosquito forceps, sharpen it to a fine point on a belt sander with water trickling onto the metal to prevent heat damage to the metal. In my case I also removed the serrations from the forceps first to match the style of the commercial vasectomy instruments.

Later I came to the conclusion that the first step was too much work and found that resorting to making a tiny (only 2mm long) hole in the skin with a #11 scalpel and then inserting an unmodified fine mosquito forceps into the tiny hole and ripping the skin open worked just as well.


The non-traumatic tissue grasping forceps can be made from a standard tissue forceps. The sharp teeth can be sanded down and the edges smoothed. I then heated the tips to soften them, and hammered the tips over a a thick nail to curve the tips towards each other. A bit of adjustment to get them to meet, properly, some final sanding and hardening the metal, and I had an instrument that could grip the Vas through the skin gently but firmly, and would do all that the commercial instrument could do. Apart from my time spent, they cost nothing, as I had the precursor instruments in my collection already. I saved $850 by doing this in about 2 hours.