What is a His Choice No Cut No Scalpel Vasectomy?

We perform no-needle, no scalpel, minimal invasive vasectomy.

No-needle. A hand held spray device (Mada Jet) is used to push the local anesthetic through the skin and into each vas deferens.

No-scalpel. Instead of cutting the skin, a small puncture is made and the elastic skin is stretched open.

Minimally invasive. This term can mean many different things but we make a single small opening in the scrotal skin. The opening is no bigger than a ‘tic-tac’ candy.

Open end technique. The lower portion of each divided vas deferens is allowed to remain open rather than intentionally closed. This is considered an open-ended vasectomy technique and provides most of our patients with an easier recovery.

This type of vasectomy (coagulation, fascial interposition, and leaving the lower end open) has been demonstrated to have the lowest failure rate, a low complication rate, and provides the least amount of pain and quickest recovery.

His Choice vasectomy can easily be performed in an office setting using local anesthesia in less than 15 minutes.

The no-needle vasectomy technique is accomplished by using a handheld spray applicator to provide local anesthesia at the beginning of the vasectomy procedure. This spray applicator is called a Mada Jet.

The spray applicator utilizes slightly pressurized air to push local anesthetic directly into the skin and around the vas deferens. This technique provides quick almost painless anesthesia. Most patients describe the sensation of receiving the anesthesia very similar to the feeling of getting lightly tapped on the skin with a small rubber band.

At the start of the procedure, each vas deferens is positioned directly underneath the scrotal skin and anesthetized with anesthetic from the Mada Jet anesthetic applicator. The anesthetic spray spreads into the scrotal skin and across the vas deferens simultaneously and is dispersed over an area about the width of a dime.

This technique provides instantaneous onset of anesthesia. Both the outside skin and the vas deferens receive local anesthesia at the same time. Only a small area of the scrotal skin and the vas deferens tubes will be numb.

We use a combination of lidocaine (quick acting and last one hour) and bupivacaine (longer acting an last about six hours) as our local anesthetic cocktail. This combination anesthetic provides pain control for up to six (6) hours.

Most patients will not experience significant pain after the anesthetic wears off. Over the counter anti-inflammatory medication is more than sufficient for pain control during vasectomy recover. Narcotic medications are not required.

A no-scalpel vasectomy procedure is accomplished by using a small pointy instrument called a no-scalpel dissector.

This instrument is used to spread a small opening in the scrotal skin. Spreading does less damage than cutting. Skin is elastic and has qualities similar to rubber. When an opening is made by spreading, the skin edges can slowly squeeze closed soon after the procedure is completed.

Typically only one small opening is made in the center of the scrotum and this opening is typically no larger than an tic-tac-candy.

Since the skin will squeeze closed…. sutures are not required!

Most patients will observe the skin opening to be almost completely closed within 24 hours.

After the skin opening is made each anesthetized vas deferens can be easily elevated through the small skin opening.

Keep in mind everything in the scrotum is mobile!

A single opening is made in the center of the scrotum but the right and left vas defers can be moved to the center of the scrotum to complete the vasectomy procedure. Each vas deferens can be divided through the one small opening made in the center of the scrotal skin.

Each vas deferens is divided using a small hand held battery device called a thermal coagulator. This device quickly divides the vas deferens and seals any small blood vessels, which could contribute to bleeding. Portions of the vas deferens are not removed during a His Choice vasectomy procedure because removing sections of the vas deferens could increase the risk of vasectomy failure.

Minimal coagulation (light burning) of the inside of the upper end of the vas is performed to accelerate closure of the vas deferens. This step significantly minimizes the risk of vasectomy failure.

Coagulation is accomplished by inserting the tip of a small hand-held, battery powered heating device into the upper most portion of the vas deferens. The device is inserted into the opening of each upper vas deferens for about ¼ inch and heat energy (thermal coagulation) is briefly applied to the inside of the upper section of each vas deferens.

Fascial interposition involves placing healthy tissue in between the divided upper and lower ends of the vas deferens. This important step minimizes the chance the divided ends can come into close contact and possibly reconnect.

Cautery of the inside of the upper tube and fascial interposition are both two critical steps to the His Choice vasectomy procedure that significantly decrease the risk of your vasectomy failing.

Fascial interposition is accomplished using one or two small titanium clips. Using clips allows the procedure to be performed more quickly and with less risk of trauma and bleeding when compared to using suture.

The titanium clips are small, non-reactive, and are difficult to feel after a vasectomy. The titanium clips are about the size of a large grain of rice.

The titanium clips and fascial interposition cause the divided ends of each vas deferens to remain separate long enough for the tubes to heal closed. This most likely happens within the first six weeks of having a vasectomy procedure.

An open-ended vasectomy minimizes the immediate buildup of pressurized sperm and fluid in the bottom end of the divided vas deferens. This allows for less pain during the vasectomy healing recovery period.

If pressurized fluid builds up in the epididymis quickly this can cause a disruption in the epididymis, more discomfort during recovery, and more of an inflammatory reaction.

Most patients question if leaving the lower end open will allow sperm to spill into their scrotum. They conceptualize their scrotum will slowly fill up like a water ballon over the next several months. Many will ask if an open ended vasectomy is harmful?

Trust us…If it was harmful…we would not do it! You can be reassured the lower end will not remain open forever.

The lower end will gradually heal closed over time. It is this gradual healing that is most likely responsible for the improved recovery after vasectomy.

Open-ended vasectomy may result in quicker recovery and less discomfort during recovery from a vasectomy. Open ended vasectomy is also thought to result in less inflammation in the epididymis than when compared to more traditional closed end vasectomy techniques.

The open-ended vasectomy procedure has been suggested to result in a healthier epididymis and a higher chance of vasectomy reversal success. This is because the sperm making system below the vasectomy site undergoes less disruption and inflammation after the initial vasectomy procedure

His Choice Vasectomy is extremely effective.

The chance of having a pregnancy after your 3-month semen sample confirms the absence of living sperm is 0.05%. This means out of every 10,000 patients up to five patients could experience a late failure.

A His Choice Vasectomy is actually one of the best vasectomy technique with the lowest chance of failure. Why?

There two (2) critical steps that reduce the chance of a reconnection of the vas deferens:

• Intra-luminal cautery of the inside the vas deferens
• Fascial interposition

Intra-luminal cautery of the inside of the vas deferens. The upper portion of each divided vas deferens is sealed with a handheld device using heat energy. The causes the upper end to heal closed more quickly. If the ends even try to reconnect there is about a 1 inch section above the division point that will heal closed because of the heat energy applied to the inside of the upper portion of the tube at the time of vasectomy.

Fascial interposition. Healthy tissue is placed between the two separated ends. Small titanium clips are used to keep the healthy tissue in place and prevent the divided end from rejoining.

This is a critical step that helps keep the two ends apart long enough for them to heal closed within the first 3 months of a vasectomy procedure.

Equally important for decreasing the risk of failure is what we do not do with a His Choice vasectomy. We do not remove any section of the vas deferens.

Removing portions of the vas deferens can actually increase the chance of a vasectomy failure