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No Scalpel Vasectomy
No scalpel vasectomy is a minimally invasive procedure invented by Dr Shunqiang Li from China in 1974. It requires the use of two special instruments. The first to isolate the vas deferens (sperm tube ) and the second to blunt dissect and expose the vas. All of this is done under local anaesthetic and inhaled analgesia to ensure no discomfort during the procedure. The benefits of this approach are reduced bleeding and post operative complications. There are no external sutures to be removed after the procedure as they are not required with such a small wound . 
Open Ended Vasectomy


Open ended vasectomy is designed to reduce post vasectomy pain syndrome (PVPS). This may occur in a small number of patients after vasectomy. By leaving the testicular end of the vas open this is reduced to one-third ( 2% ).  This is similar to the background rate of significant testicular pain in any 12 month period experienced by adult males. 

Open ended vasectomy is thought to reduce pressure in the epididymus by avoiding sperm build up. The vast majority of men who experience PVPS will get better spontaneously with time. It is important however to seek assistance if this happens as there are interventions that can help. 

Mucosal Cautery MC and Fascial Interposition FI
Nature has ways of trying to rejoin the vas ends after they are interrupted.The MC and FI technique had the lowest failure rate in the American Urology Association review article of 2012 and fits well with the open ended approach. It involves diathermy of the prostatic end of the vas and the the suturing or application of clips to close the fascial layers back around the end of the vas. This provides a barrier of living tissue to prevent inflammatory micro tubules re-joining the ends.  
These three combined approaches have been described as the "ideal technique."
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