What is His Choice No Scalpel Vasectomy?

His Choice Vasectomy is minimally invasive vasectomy performed through a single small, midline scrotal incision without using a needle or a scalpel. 

Local anesthesia is provided without using a needle. Instead of a needle, a small, hand held device sprays the local anesthetic through the skin.

A small skin opening is made in the center of the scrotum using a device that spreads a small opening in the skin to take advantage of the natural elasticity of the skin. This allows the natural elasticity of the skin to squeeze the opening closed within the first 24 hours.

The vasectomy is extremely effective and has a low risk of failure. After successfully completing the 3 month semen sample the chance of a late failure is less than 5 failures out of every 10,000 procedures. 

The risk of vasectomy failure is low after a His Choice Vasectomy because of two important steps that happen after the vas deferens is divided.

Step 1. Coagulation

The upper end of the divided vas deferens is sealed with thermal coagulation (heat energy). This decreases the chance of a reconnection if the tubes fall back into alignment.

Step 2. Fascial interposition

Healthy tissue (fascial interposition) is placed between the two divided ends to further decrease the chance of a reconnection.

The lower portion of each divided vas deferens is allowed to remain open rather than closed. This is considered an open ended vasectomy technique.

This type of vasectomy (coagulation, fascial interposition, and leaving the lower end open) has been demonstrated to have one of the lowest failure rates, a low rate of complications, and a quicker recovery.

A His Choice vasectomy can easily be performed in an office using local anesthesia in less than 12 minutes. 

No tissue is removed or excised during a His Choice vasectomy. Our patients leave with the same stuff they brought when they walked into our office.

The no-needle vasectomy technique is accomplished by using a handheld spray applicator to provide local anesthesia at the start of the vasectomy procedure. This spray applicator is called a Mada Jet. This device is sometimes used to provide anesthesia for dental, dermatologic, and urologic procedures. 

The spray applicator utilizes slightly pressurized air to push the local anesthetic directly into the skin and vas deferens. This technique provides quick anesthesia and minimizes the risk of needle injury to blood vessels that can sometimes occur with needle-administered anesthesia.

At the start of the procedure, each vas deferens is positioned directly underneath the scrotal skin and anesthetized with a puff of anesthetic from the spray applicator. Most patients describe the sensation as if they got lightly ‘tapped’ on the skin with a small rubber band.

The anesthetic spray superficially spreads into the scrotal skin and directly into the vas deferens. The anesthesia covers about the same area as the width of a dime. This provides an almost instantaneous onset of anesthesia and anesthetizes only the area on the scrotal skin and around each vas deferens where the vasectomy procedure will occur.

We use a combination of lidocaine and bupivacaine as our local anesthetic cocktail. The lidocaine works right away and lasts for one (1) hour. The bupivacaine takes longer to start working but provides longer pain relief for up to six (6) hours.

Most patients will not experience significant pain after the anesthetic wears off.

The no-scalpel technique is accomplished by using a small pointy instrument called a no-scalpel dissector. 

This instrument is inserted into the anesthetized skin and is used to spread a small opening in the scrotal skin. The skin is elastic. A small opening can be stretched and the skin will gradually squeeze closed after the procedure. Typically only one small opening is made in the center of the scrotum and this opening is usually no larger than a tic-tac-candy. 

The anesthetized vas deferens can easily be elevated through the small skin opening.

This area will usually heal closed within 24 hours and without the need for any sutures.

Each vas deferens is divided using a small hand held battery device called a thermal coagulator. Although this may sound intense, the thermal coagulator is powered by two AA batteries.

The coagulator 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.

Minimal coagulation of the inside of the upper end of the vas is performed to accelerate closure of the upper part of the vas deferens. This step greatly minimizes the risk of vasectomy failure. 

Coagulation is accomplished by inserting the tip of the thermal coagulator into the upper most portion of the vas deferens (proximal portion). The device is inserted into the opening of each divided 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.

Minimal coagulation is preferred over extensive coagulation to better accelerate closure, minimize extensive tissue damage and inflammation, and minimize the risk of vasectomy failure.

An open-ended vasectomy technique minimizes the immediate build-up of pressurized sperm and fluid in the lower end of the divided vas deferens. Increased pressure in the lower end of the divided vas deferens can cause disruption in the epididymis, more inflammation, and more discomfort during vasectomy recovery.

Most patients are concerned that leaving the lower end open will allow sperm to spill into their scrotum for the rest of their lives. Many will ask if this is harmful? 

You can be reassured the lower end will not remain open forever. The lower end will gradually heal closed over time. The key word is gradual. 

It is this gradual healing that is most likely responsible for the improved recovery after His Choice vasectomy.

Open-ended vasectomy has been suggested to result in quicker recovery, less discomfort, and less inflammation in the epididymis than a closed-end vasectomy. 

The open-ended vasectomy procedure has been suggested to result in a higher chance of sperm recovery success after vasectomy reversal because the epididymis undergoes less disruption and inflammation after the initial vasectomy procedure.

More information: [Advantages of an open-ended vasectomy]

Fascial interposition involves separating the divided ends of the upper and lower vas deferens by interposing healthy fascial tissue between the two divided ends. This technique minimizes the chance the divided ends can come into close contact and possibly reconnect.

The lower end is allowed to remain open and fascial interposition is effectively accomplished with small titanium clips. Using clips allows the procedure to be performed more quickly and with less risk of trauma and bleeding than can occur when 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 clips are not placed across the vas deferens. Instead they are placed in alignment and parallel to each vas deferens. Since the clips are smaller than the vas deferens they are much harder to feel externally.

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 (6) weeks after having a vasectomy procedure.