Vasectomy and Vasovasostomy - Male Contraception

Vasectomy Surgery

Vasectomy is a minor operation that takes about 15 - 30 minutes and is usually performed with local anesthesia in a doctor's office or a family planning clinic. Most insurance policies will cover vasectomies performed as a minor outpatient procedure, but will not cover vasectomies performed as major surgery in an operating room. If a Vasclip procedure is performed, there may be an additional cost for this device.

Conventional Vasectomy

A conventional vasectomy procedure is performed as follows:

• To prevent increased risk of bleeding, patients should avoid taking aspirin or NSAIDs [ibuprofen (Advil), naproxen (Aleve)] for several days prior to the procedure.
• Before the operation, the patient's scrotum is shaved and cleaned.
• A local anesthetic is injected into the skin of the scrotum over where the vasectomy will take place. An anesthetic cream may be applied before the injection to reduce its pain.
• The surgeon makes a tiny incision on one side of the scrotum and locates one vas deferens. The vas deferens is isolated, drawn through the incision, and clamped at two sites close to each other.
• The segment between the clamps (which should be more than 15 mm, or a little over 1/2 inch) is then removed.
• The surgeon then seals off (ligates) the tube with sutures and cauterizes it with an electric needle. Fascial interposition is an additional technique that may be used in combination with these methods to improve chance of permanent closure. With fascial interposition, the surgeon pulls the fibrous layer covering the vas (the fascia) over the cut end of the vas and sews it closed. This increases the barrier and further reduces residual sperm. Research suggests that cauterization, with or without fascial interposition, is the best method for sealing off the vas.
• The surgeon may choose to close off either one end of the vas (called an open-ended procedure) or both ends (closed-ended technique). In the open-ended procedure, the vas section connected to the testis is left open, and the one leading to the prostate is sealed. In the closed-ended approach, both are sealed. Many surgeons prefer the open-ended version because it has lower complication and failure rates than the closed-ended method, and it results in fewer cases of chronic pain.
• After closing off the tube, the vas deferens is gently placed back into the scrotum.
• The procedure is then repeated on the other side.
• After a short rest, usually about half an hour, the patient can leave the doctor's office or clinic. Arrangements should be made ahead of time for someone to drive the patient home.

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