The Vasectomy Procedure in Brief Detail
RELAXATION
You will be given a 2mg. tablet of Ativan (lorazepam) when you schedule your appointment. You will take this about 1 hour prior to your appointment. I have found that this helps reduce any anxiety you may have about having the vasectomy performed. This usually makes most guys feel like they’ve had a few drinks pretty quickly – where the teeth start to feel a bit “tingly”. For this reason I ask that you NOT drive yourself to or from the office, and instead arrange for a “chauffeur” for the procedure.
ARRIVAL AND PREPARATION 
No scalpel vasectomy takes about 60 minutes in the office. The time taken to perform the actual surgical procedure is about 30 minutes, the other 15 minutes involve preparation and finalization of your procedure.
When you arrive in our office you are taken into the procedure room. You will remove your pants and underpants and lay down on the table. You will be given a sheet to cover with. We then place an elastic band around your penis to keep it out of the way of the procedure. The elastic is then clipped to your shirt to expose the scrotum.
The surgical assistant then cleans the scrotal area with Hibiclens. Finally, you are covered with sterile surgical drapes and the scrotum is brought through an opening in the drapes. This preparation (sterile scrub, draping, and readying the instruments) will take about 10 minutes.
NUMBING OR ANESTHESIA
Local Anesthesia
The standard method for numbing the surgical site is to inject a small amount of numbing solution into the scrotal skin.
I then inject a little more freezing solution alongside each sperm tube. This will cause a momentary pressure sensation, and after that you should not feel anything.
BEGINNING THE VASECTOMY
Once the area is frozen, I re-locate the vas tubes one at a time. I gently hold each vas tube between my fingertips, and grasp them with a specially designed ringed clamp. With a pair of special forceps, I make one tiny puncture into the skin on the scrotum. This small opening made in the scrotum is about “1/4” (approximately 4 millimeters long), and represents the true size of the opening needed to work through. With the same instruments I gently lift each vas tube out through this opening.
BLOCKING THE VAS DEFERENS PERMANENTLY
There are many ways to block the vas deferens or vas tubes to prevent sperm flow. How they are blocked differs among no-scalpel vasectomy physicians. For example, once the vas tubes have been brought out through the opening in the scrotum, some involve just cutting and tying the ends of the tube. Others cauterize (burn) the ends. Still others affix metal clips to the ends or use plastic clips designed especially for the vasectomy procedure. Combinations of any of these are possible and affect your long term outcome and failure rates.
I use a combination of 4 steps to ensure that your vasectomy is successful, and permanent with the lowest failure rate.
- I remove about 1″ of the vas deferens to keep the tubes apart.
- I cauterize (burn) the inside of only one end of the tube to get it to scar shut. I do not burn the inside of the other end of the tube.
- I tie a permanent suture around the one end of the tube that I cauterize to further block it.
- I do an additional fourth step: “fascial interposition”, where I place one tube back into the surrounding tissues I removed it from and tie that closed. The other end of the tube remains outside of this so a layer of tissue is between the cut ends of the tubes.
These 4 steps prevent the tubes from growing back together again. In more than 25 years of performing, and instructing other physicians to perform no scalpel vasectomies, I have had no failures however, I can NOT offer a 100% success rate as “miracles” do happen.
FINISHING UP
Finally we gently place the separated and blocked ends back in the scrotum. The same procedure is done through the same small opening on the other vas deferens. The opening in the scrotum is then cleansed with sterile water and dried.
The one small skin opening closes itself without stitches, but we apply several small tape strips to hold the wound edges together. This is then covered with a gauze pad, and you put on your athletic supporter and clothes. Within days the opening heals almost without a trace.
HEADING HOME
After relaxing for a few minutes, I will review your post vasectomy instructions and give you 2 labeled specimen bottles to return your samples at 2 and 4 months after the procedure. At this time most men have no trouble walking out to the car and havng their “chauffeur” drive them home.
