There's More Than One Way to Perform 'The Snip'
It's possible the dialogue surrounding pet population control—specifically, castration—has an unfortunate overlap with some people's impression of vasectomies.
Of course, this particular form of human contraception does not entail anything as extensive as chopping off testicles. Vasectomies are much tamer and, simultaneously, diverse than they probably play out in the mind.
A vasectomy stops the supply of sperm to the semen by cutting and sealing the tubes, known as the vasa deferentia, that carry sperm. Procedures include the traditional vasectomy and the no-scalpel vasectomy, which differ in technique and instrument used, though neither is more invasive than the other, said Wael Almajed, M.D., a urologist and sexual medicine specialist on fellowship with Tulane University in New Orleans.
To most folks, anything surgical connotes a scalpel. While the no-scalpel method obviously doesn't use a scalpel, it's worth noting sharp, pointy things tend to remain involved. Doctors use a very small instrument, like a mini-scissors, instead of a scalpel to make the cut, Almajed said.
"I would say it's a provider's choice, but I would say they have very similar outcomes and probably the pain from the procedures is quite similar," he said.
Cutting through the vasectomy details
Matthew J. Mutter, M.D., a urologist and men's health clinician with LSU Health New Orleans, has a fair amount of confidence in his own vasectomy approach. He laid out the steps.
You anesthetize the skin in the vas deferens and grab it with a clamp through the skin. From there, you use a very sharp hemostat—a tool that you can spread—to puncture the skin. Then put the hemostat within this little puncture hole and spread the skin, creating a 2- to 4-millimeter incision without a knife in the skin. Pull the vas deferens up through the skin and do the vasectomy.
"Now, once you get it up through the skin, there are many different ways to, I guess, kind of 'do the deal,' if you will," Mutter said.
The American Urological Association lists several methods of performing a vasectomy.
"One of the ways is to simply cauterize—not actually incising or separating the vas deferens—but only cauterizing 2 centimeters' worth of vas deferens," Mutter said. "So you make no removal of the vas. You don't cut it in half, you do none of that, you simply cauterize it in centimeters."
Regardless of the technique employed, the general idea is to prevent the vas deferens from performing its job, which is transporting sperm cells.
"There are other ways of what we call ligation, so that's tying off the ends," Mutter added. "And there's another way of doing it called fascial interposition—once you've excised a portion of the vas deferens, you actually put a piece of tissue in between the two ends."
Combining methods
Mutter uses an amalgamation of different techniques and tools in the process.
"The way that I do a vasectomy is not in the truest form a 'no-scalpel' vasectomy," he said. "After I numb up the skin, I use a needleless injector...it basically injects pressurized lidocaine, so there's no needle in it. It really kind of feels like getting thumped in the scrotum with a rubber band—that's kind of the best way I can describe it."
While a rubber-band flick to the scrotum doesn't exactly sound appealing, most men might take that particular office supply over scalpels, scissors or other such implements.
Mutter gets hands-on in the next stage.
"And then I just localize and I grab the vas with my fingers, and then I use a very small scalpel. The same size incision that you would get with the no-scalpel technique is the same size that I do," he said. "I use the scalpel, so technically, it's not a no-scalpel vasectomy. But for me, it's faster and it's cleaner to get into the scrotum than to use this sharp hemostat to separate the skin and that sort of thing. So for me, personally, it's easier on the patient and it's a lot faster."
After that, he makes the finishing step sound like little more than tying your shoes or putting a bow on a gift: "So once I have the vas deferens itself, I excise a portion, I cauterize the inside. And then, when I tie the edges over, I tie them over in a 'J' fashion."
It's a difficult visualization for people without a detailed understanding of reproductive anatomy, but basically, the two separated ends of the vas deferens are curled and directed away from each other. If you take your two pointer fingers, point them straight, curl them and then put your fingers together by the knuckle, it kind of shows you the result of Mutter's method.
All of this is to say it's difficult to understand the nuances and complexities of interacting with the human body surgically. But doctors and surgeons have many options for successfully completing a vasectomy, and nearly all of them are present at some stage in Mutter's method.
Mutter said his technique can take place on a Friday and the patient can be back at work Monday morning. Most people take about a week to recover from a vasectomy, in general.
Numbers associated with successful pregnancy after vasectomy vary due to the types of procedures and individual implementation of those procedures. The best answers about your own vasectomy's potential effectiveness are going to come from your own doctor.
