Currently, up to a half million men in the United States undergo vasectomy each year (Barone, 2006; Eisenberg, 2010). And 5 percent of women rely on this method for contraception (Daniels, 2015). For sterilization, the vas deferens lumen is disrupted to block the passage of sperm from the testes. Most commonly, a no-scapel vasectomy (NS) accomplishes this with one specialized instrument that grasps the vas deferens and surrounding skin together. A second dissector tool punctures the skin and then isolates the vas (Rogers, 2013). As clariied by the American Urological Association, minimaly invasive vasectomy includes any vas isolation procedure, including the no-scalpel technique, which uses a skin incision measuringr:;1 cm and requires minimal vas dissection (Fig. 39-5) (Sharlip, 2012). Compared with conventional vasectomy that employs incisions > 1 cm and greater dissection, the no-scalpel technique is associated with fewer minor surgical complications, but each is equally efective (Cook, 2014).
ing the first year is 9.4 per 1000 procedures and 11.4 per 1000 at 2,r3, and 5 years Qamieson, 2004). Failures result from unprotected intercourse too soon after ligation, incomplete occlusion of the vas deferens, or recanalization (Awsare, 2005; Deneux-haraux, 2004).
Other than regrets, long-term consequences are rare. One is troublesome chronic scrotal pain, which develops in up to 15 percent of men (Leslie, 2007; vlanikandan, 2004). Previous concerns for atherogenesis, immune-complex mediated disease, testicular cancer, and prostate cancer have been allayed by a number of investigators (Bernal-Delgado, 1998; Giovannucci, 1992; Goldacre, 1983; M0ller, 1994).
Reanastomosis of the vas deferens can be completed most efectively using microsurgical techniques. In general, conception rates following reversal are adversely afected by longer duration from vasectomy, poor sperm quality found at reversal, and type of reversal procedure required (American Society for Reproductive Medicine, 2008).
Al-Safi ZA, Shavell VI, Hobson DT, et al: Analysis of adverse events with Essure hysteroscopic sterilization reported to the Manufacturer and User Facility Device Experience database. J Minim Invasive Gynecol 20(6):825, 2013
American College of Obstetricians and Gynecologists: Access to postpartum sterilization. Committee Opinion No. 530, July 2012, Reairmed 2016 American College of Obstetricians and Gynecologists: Benefits and risks of sterilization. Practice Bulletin No. 133, February 2013, Reairmed 2017a
American College of Obstetricians and Gynecologists: Salpingectomy for ovarian cancer prevention. Committee Opinion No. 620, January 2015b, Reairmed 2017b
American College of Obstetricians and Gynecologists: Sterilization of women: ethical issues and considerations. Committee Opinion No. 695, Apri 20l7c
American Society for Reproductive Medicine: Vasectomy reversal. Fertil Steril 90:S78, 2008
American Society for Reproductive Medicine: Role of tubal surgety in the era of assisted reproductive technology: a committee opinion. Fertil Steril 103(6):e37,n2015