No-scalpel vasectomy: a cautionary tale of failure



We would like to share with your readers some lessons learned after failures recently experienced with the no-scalpel vasectomy technique. This technique has been in use since the 1970s and is minimally invasive. It has a lower incidence of postoperative pain, infection and swelling, with a faster recovery time. The average time spent off work is ≈ 3 days with the traditional technique, but 1.5 days is normal for the no-scalpel technique. The failure rate with the traditional technique is ≈ 0.5%, but with the no-scalpel technique is 0.2%[1]. In a 13-month period (August 1999 to August 2000, group A), 113 men had a vasectomy under local anaesthetic using the no-scalpel technique at the day surgery unit at our hospital. Five failures were discovered, with confirmation of motile sperm being present in the 14-week semen sample, giving a failure rate of 4.4%. The operating surgeons for the failures ranged in experience from SHO to consultant. In the following 13 months (September 2000 to September 2001, group B), 67 men had a vasectomy under local anaesthetic using the no-scalpel technique, but with an intention to remove a longer section of vas; there were no failures in this group.

The mean (range) length of vas removed in the five failures was 6.5 (4–22) mm; the lengths of vas in a random sample of nine successful vasectomies from the same group (A) showed a mean of 10 (5–20) mm. In group B, in which there were no failures, the mean length removed was 15 (6–25) mm. In this retrospective analysis there appeared to be an association between vasectomy failure and shorter length of vas removed. The mean and median lengths of vas in vasectomy failures were nearly half those of the successes in the same group. A conscious removal of longer segments of vas appears (in group B) to protect against failure. The minimally invasive vasectomy technique, although desirable, does not mean removing a minimal length of vas.