Vasectomy instead of Condoms

Well this morning we're going to do a no scalpel bestctomy and I'm going to show you the difference between that and the at least the technique where we normally would do an incision to do the old-fashioned bestctomy. I think the no scalpel is much better. It's less

dissection so it's less traumatic to the patient. I hardly ever see any swelling post-op and patients do very well. Hard to get any complaints. So here I'm just scrubbing, cleaning up the area I'm going to go through and this is the midline. So I go right in through here and basically I put some local anesthetic right here and this is the cord and that's the testicle. So I use the same needle to inject a little bit of medicine along the back stuff is on the cord here.

And I can feel the bass right between my fingers. Same thing on this side. I feel it right there. So I put in about 10 cc's of lighter cane or xylokane whatever it's called.

Basically you go in and get the bass through a tiny opening and I'm going to show you the instruments while I'm doing it. It's a very tiny needle, 25 gauge. So basically I give you a little stick here. Are you feeling anything? A little bit. So a little bit of infiltration in the skin right here. Can you zoom in right here? And then I just direct it to the left side and I can feel the bass difference.

And I put in another few cc's right here. That's about half the syringe goes in on one side and the other half goes to the other bass difference. And that's about it. That's the most painful part of the operation. In about 5-10 minutes there's hardly any sensation and we do the procedure. So I clean the area again

before we start and I will briefly explain how the normal bass sacram is done and then we'll go to the no scalpel technique. So this is the midline or the center of the scrotum and this area is already injected with lighter cane so he's not going to feel much pain here. Normally when we do a bass sacram the old fashioned way we could even make an incision in the middle then go and find the core on each side and take out the bass. Or most people have an incision here and here over each cord and

then they try to bring the whole cord out a part of the cord and find the bass and take it out. But here you're really going just through a small so now that it's already infiltrated with lighter cane you don't feel any pain. I can pinch that no pain there. And what I do is I use this clamp special clamp to find the bass and close in on it right through the skin and I'll show you how we do that. And then I have a special clamp

which is like a regular clamp, but it's pretty sharp right here. And what it does it hooks the skin and makes a tiny opening and I use that to find the bass and pull it out. So I'll show you that. The most stripping of this tissue around it then be isolated. Take it back out. You've seen it okay stuff? See here we have it totally isolated from the rest of the cord. So I get a loop of bass stuff right here and you see all the other tissue with blood vessels over there.

So all I'm going to do is get this separated and then tie off a little piece of it. I'm just going to get a different suture. All this stuff, but this one is kind of hard to see. So now I got the suture that I'm going to tie the bass with. Can you see it? You can see it and I can't. So I actually take a little piece off like a centimeter or centimeter and a half and I slide the suture all the way

away from the testicle. Testicle end of the cord and go ahead and put a stitch. I'll put a tie cut off a little tag. This is the testicle end of the bass that I'm tying. Again I'm cleaning off the bass with some betadine

and it's really not much bleeding. Just a couple of

ccs of blood. I'm going to put one more tie just for safety or insurance

because we don't want this to go back together. Right?

Okay, so now we have a segment of the bass stuff and this one stitch there and a couple of stitches here. So now I excise the segment right here. Remove and this is the part that's coming out. Are you okay, though?

So it's just a small segment that's taken out.

Right about there.

So that's the bass stuff. Just a little piece of it.

Less than a centimeter and then I grab the bass, the rest of the bass and make sure everything looks okay. But there's not any bleeders.

So I just swab again with some betadine

and it looks pretty good. You can see that's one end right there and this is the other end here. So I just let this all go back in and it disappears. Right there. The opening is really small and now we go in and get the other side.

So now I'm going to insert the bass grabbing clamp right through it and then find the bass.

So here we have it totally isolated from the rest of the cord.

So I get a loop of bass stuff from right here and you see all the other tissue with blood vessels over there. So all I'm going to do is get this separated and then tie off a little piece of it. I just want to get a different suture. You know, stuff like this one is kind of hard to see.

So now I got the suture that I'm going to tie the bass with.

Can you see it? You can see it and I can't.

So I actually take a little piece off like a centimeter or centimeter and a half and I slide the suture all the way away from the testicle.

Testicle end of the cord and go ahead and put a stitch.

I'll put a tie and go ahead and cut off a little tag. This is the testicle end of the bass that I'm tying. Again, I'm cleaning off the bass with some betadine and it's really not much bleeding. Just a couple of cc's of blood. I'm going to put one more tie just for safety or insurance because we don't want this to grow back together. Right? Okay. So now we have a segment of the bass stuff and this one stitch there and a couple of stitches here. So now I excise the segment right here.

Remove and this is the part that's coming out. Are you okay, Raul? Oh yeah, I'm fine now because I hope to use any part of this. So it's just a small segment that's taken out.

Right about there. You can come down a little bit more over there.

So that's the bass definitely. Just a little piece of it, less than a centimeter.

And then I grab the bass, the rest of the bass and make sure everything looks okay. But there's not any bleeders. So I just swab again with some betadine and it looks pretty good. You can see that's one end right there and this is the other end here. So I just let this all go back in and it disappears right there. The opening is really small and now we go in and get the other side. Put a clean 4x4 on top of the betadine and then it's covered up.

I'll show this part. Okay Raul, all done.