POINT / COUNTERPOINT : Scalpel vs. No-Scalpel Vasectomy

Vasectomy is a popular male contraceptive option. An estimated 336,000 vasectomies were performed in 1987, according to the Association for Voluntary Surgical Contraception.

In recent years, more doctors have begun to perform a “no-scalpel” technique, which uses a clamp-like instrument to pierce the skin.

Doctors disagree on which technique is better. Here, two doctors debate the traditional versus no-scalpel techniques.

No-Scalpel: Dr. Barton Wachs, urologist, Long Beach Memorial Medical Center; clinical instructor in urology at Harbor/UCLA Medical Center

“When a physician says, ‘Hand me the scalpel,’ or ‘May I have the knife?’ men about to undergo a vasectomy get scared.

“With a no-scalpel vasectomy, they do not hear this. In this technique, the scrotal skin is infiltrated with local anesthesia. A ringed forceps traps the vas deferens (sperm-carrying duct) against the skin.

“A sharpened hemostat (a clamp-like instrument) pierces the skin. The vas is cut in half and occluded by a standard technique such as cautery, tying off with a suture or cutting.

“The puncture wound contracts to a few millimeters immediately, eliminating the need for sutures, and leaves little or no scar. There is no bleeding. There is less pain. Patients are told not to lift anything or exercise for 24 hours.

“The chance for reversal is the same for both techniques. This method makes vasectomy more attractive, especially for men who fear the knife.”

Traditional: Dr. Stanwood S. Schmidt, a Eureka, Calif., urologist; author of published studies on vasectomy

“What is the old saying about ‘Don’t be the first to accept or the last to reject something new?’

“Traditional vasectomy works fine. I use local anesthesia and verbal analgesia to talk patients through it. The scalpel provides a cleaner job. As far as the length of the incision, I make it no longer than a half-inch. Then I cut the (sperm-carrying) tube and cauterize each end.

“I do put a stitch in the skin. I could do it without a stitch, but it is safer with a stitch. Most (patients) are back to work the next day. I see them four or five days later to check the wound and take out the stitches.

“Most doctors who have jumped on the no-scalpel bandwagon are not surgeons but general practice physicians who do vasectomies occasionally.”