The specific steps performed by Dr. Mistry have been carefully thought out to maximize the effectiveness of the procedure and minimize pain and complications.
No Needle | No-Scalpel
Single Incision | No Metal Clips | IV sedation Vasectomy
For those that choose IV sedation, a small needle is placed in a vein in the hand or arm by a licensed nurse anesthetist. The needle is then used to inject the necessary amount of sedative to allow relaxation of the senses and the scrotum. IV placement allows for additional medication to be administered during the procedure if necessary.
After the scrotal skin is cleaned with an anti-bacterial solution, sterile drapes are placed to isolate the genitals.
A needless injector is then used to anesthetize the skin over the vas-deferens. The needle-less injector seems right out of Star Trek but has been around for more than a decade. The numbing medication is carried by a high-pressure air jet into the skin. This eliminated the need for a needle and can allow for the anesthetic to penetrate deep into the skin.
After the skin is numb, a ringed forcep is used to grasp the left vas deferens through the skin. The skin is then pierced with a very sharp tool to expose the vas deferens. This “no-scalpel” technique results in a smaller incision in the scrotum, can allow both vas deferens to be accessed through a single incision and faster overall healing.
Once the vas deferens is isolated, the nerves, blood vessels, and surrounding tissue are carefully stripped. Dr. Mistry spends more time on this step that many others who perform a ‘five-minute vasectomy’ to ensure that excess tissue is not ‘bundled-up’ and lead to postoperative pain. A long segment of the vas deferens is then cut with the ends cauterized. Our special ‘vas-tip’ cautery allows for burning of the inner portion of the vas deferens.
The cut ends are then tied using a suture that dissolves in 6-8 weeks. Dr. Mistry does not use metal clips despite the added time it takes to tie the tubes closed. Metal clips never dissolve and can be felt through the skin by many men. In addition, using permanent suture may lead to the entanglement of nerve tissue and contribute to long term pain. The use of sutures also allows each end to be separated from one another to further prevent an ‘auto-reversal’ from occurring.
Dr. Mistry does not perform the ‘open-ended vasectomy’ where one of the ends of the vas deferens is left untied. The benefit of this procedure in reducing post-procedure pain is unconvincing and the increased rate of sperm granuloma formation causes unneeded patient distress.
After the left vasectomy is performed, the same incision is used to find the right vas deferens and the procedure is repeated.
Generally, the vas deferen specimens are sent to pathology for identification.
After both sides are completed, the areas are closely inspected for any unexpected bleeding. The skin incision is not closed. This allows for less bruising and decreases the chance of post-operative infection. Also, a stitch in the scrotum can be irritating to the penis. The incision is dressed with anti-bacterial ointment and a single folded piece of gauze.