Scalpel versus no-scalpel incision for vasectomy

 

Abstract

Background

Currently, the two most common surgical techniques for approaching the vas during vasectomy are the incisional method and the no-scalpel technique. Whereas the conventional incisional technique involves the use of a scalpel to make one or two incisions, the no-scalpel technique uses a sharp-pointed, forceps-like instrument to puncture the skin. The no-scalpel technique aims to reduce adverse events, especially bleeding, bruising, hematoma, infection and pain and to shorten the operating time.

Objectives

The objective of this review was to compare the effectiveness, safety, and acceptability of the incisional versus no-scalpel approach to the vas.

Search methods

In October 2011, we searched the computerized databases of CENTRAL, MEDLINE, POPLINE and LILACS. We looked for recent clinical trials in ClinicalTrials.gov and the International Clinical Trials Registry Platform. Previous searches also included in EMBASE. For the initial review, we searched the reference lists of relevant articles and book chapters.

Selection criteria

Randomized controlled trials and controlled clinical trials were included in this review. No language restrictions were placed on the reporting of the trials.

Data collection and analysis

We assessed all titles and abstracts located in the literature searches and two authors independently extracted data from the articles identified for inclusion. Outcome measures included safety, acceptability, operating time, contraceptive efficacy, and discontinuation. We calculated Peto odds ratios (OR) with 95% confidence intervals (CI) for the dichotomous variables.

Main results

Two randomized controlled trials evaluated the no-scalpel technique and differed in their findings. The larger trial demonstrated less perioperative bleeding (OR 0.49; 95% CI 0.27 to 0.89) and pain during surgery (OR 0.75; 95% CI 0.61 to 0.93), scrotal pain (OR 0.63; 95% 0.50 to 0.80), and incisional infection (OR 0.21; 95% CI 0.06 to 0.78) during follow up than the standard incisional group. Both studies found less hematoma with the no-scalpel technique (OR 0.23; 95% CI 0.15 to 0.36). Operations using the no-scalpel approach were faster and had a quicker resumption of sexual activity. The smaller study did not find these differences; however, the study could have failed to detect differences due to a small sample size as well as a high loss to follow up. Neither trial found differences in vasectomy effectiveness between the two approaches to the vas.

Authors' conclusions

The no-scalpel approach to the vas resulted in less bleeding, hematoma, infection, and pain as well as a shorter operation time than the traditional incision technique. No difference in effectiveness was found between the two approaches.

 

Plain language summary

Scalpel or no-scalpel approach to the vas

Vasectomy is a surgical method used in men to cut or tie the vas deferens. The vas is a tube that delivers sperm from the testicles. The purpose of vasectomy is to provide permanent birth control. Usually the operation involves cutting the skin of the scrotum with a scalpel. A newer technique uses a sharp instrument to puncture the skin instead. The intent is to have fewer problems with bleeding, bruising, and infection. This review looked at whether the no-scalpel approach to the vas worked as well as the scalpel method. It also studied any side effects of the methods and whether the men liked the method.

In October 2001, we did a computer search for studies comparing the no-scalpel approach to the vas with the scalpel method. We included randomized controlled trials in any language. For the initial review, we also looked at reference lists of articles and book chapters.

We found two trials that looked at the no-scalpel approach to the vas. The trials had somewhat different results. The larger trial showed the no-scalpel method led to less bleeding, infection, and pain during and after the procedure. The no-scalpel approach required less time for the operation and had a faster return to sexual activity. The smaller study did not show these differences. However, the study may have been too small and many men dropped out. The two methods did not differ in the numbers of men who became sterile.

 

摘要

背景

於輸精管結紮使用手術刀切口與非手術刀切口之比較

目前在行輸精管結紮時，接近輸精管最常用的方式有兩種，分別是切開法與不使用手術刀的技術。傳統的切開法使用手術刀劃開一到兩個切口，非手術刀的技術使用一個尖頭類似鑷子的器械刺穿皮膚。後者目的在於減少不良事件、血腫、感染、疼痛，並縮短手術時間。

目標

這篇回顧研究目的在於比較這兩種方法的有效性、安全性以及可接受度。

搜尋策略

我們在 2006 五月，搜尋了 CENTRAL、MEDLINE、EMBASE、POPLINE 及 LILACS 等電腦化的資料庫，另外也搜尋了相關文章及書籍章節的參考文獻列表。

選擇標準

這篇回顧包括了隨機分派對照組的試驗及有對照組的臨床試驗。這些試驗並沒有語言限制。

資料收集與分析

我們評估了文獻搜尋中所有的標題與摘要，並由兩位獨立的作者將資料從可引用的文獻中擷取出來。結果的測量包括安全性，可接受性，手術時間，避孕效果以及終止。

主要結論

有兩個評估非手術刀技術的隨機分派對照組的試驗，其結果並不相同。其中較大型的試驗顯示新方法的後續追蹤比起標準的切開法，有較少的手術時間(勝算比為 0.49，百分之 95 信賴區間為 0.27 到 0.89)、手術時的疼痛(勝算比為 0.75，百分之 95 信賴區間為 0.61 到 0.93)、陰囊疼痛(勝算比為 0.63，百分之 95 信賴區間為 0.50 到 0.80)以及切口感染(勝算比為 0.21，百分之 95 信賴區間為 0.06 到 0.78)。兩個研究都發現非手術刀技術的血腫較少(勝算比為 0.23，百分之 95 信賴區間為 0.15 到 0.36)。非手術刀的技術手術需時較短，且能較早恢復性生活。然而較小型的研究沒有發現這些差異。然而這可以歸因為樣本較小且後續追蹤失去比率高，導致無法顯示這些差異。沒有試驗發現兩種手術方式的輸精管結紮成功率有差異。

作者結論

非手術刀接近輸精管的方式比起傳統的切開法，產生較少的出血、血腫、感染、疼痛以及手術時間。兩者的成功率相當。

翻譯人

本摘要由臺灣大學附設醫院陳俊葦翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

使用手術刀或非手術刀來接近輸精管，是將男人的輸精管切斷或結紮的外科方法。輸精管是將精子送出睪丸的管狀構造。輸精管結紮的目的在於永久性的控制生育。這項手術通常需要使用手術刀切開陰囊的皮膚。較新的技術乃採用尖銳的器械取代刀片來刺穿皮膚。 其目的在於減少出血、瘀青及感染的問題。這篇回顧在於尋找新方法的功效是否和手術刀法相同，並研究任何副作用及喜好程度。我們電腦化的搜尋關於兩種方法比較的研究，並且搜尋文獻及書籍章節中的參考文獻列表。我們引述任何語言的隨機分派對照組的試驗，發現有兩項試驗探討非手術刀接近輸精管的技術。這兩項試驗的結論有些許差異，較大型的試驗顯示非手術刀的方法產生較少出血、感染、術中及術後疼痛，且手術需時較短，較快恢復性生活。較小型的試驗就沒有發現這些差異。然而這可能是因為樣本數較少且許多人失去追蹤。這兩種方法在節育的成功率則相同。