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A Vasectomy Without The Unkind Cut


Personal Business: HEALTH

A VASECTOMY WITHOUT THE UNKIND CUT

Each year, about 400,000 men in the U. S. have vasectomies. Usually done on an outpatient basis, the procedure typically takes less than 20 minutes and entails little medical risk. But now, U. S. doctors are using a new technique that makes the operation even quicker and safer. Called a no-scalpel vasectomy, it eliminates a major fear many men must conquer before they can consider this family-planning option.

The no-scalpel method was developed in China and has already been performed on some 8 million men. In the late 1980s, a medical team led by Marc Goldstein of New York Hospital-Cornell Medical Center studied the technique in China and returned to teach it to American physicians. Now, says the Association for Voluntary Surgical Contraception in New York, about 300 urologists and family-practice doctors are trained. "Every doctor who learns it switches," says Sheldon Freedman, a Las Vegas urologist who routinely performs five no-scalpel vasectomies a week.

NO NICKS. In the traditional method, doctors numb the scrotum with a local anesthetic. Then they use a scalpel to make one or two 1/4-inch incisions to reach each of two thin tubes, called vas, through which sperm travel to the seminal fluid. The new technique dispenses with the scalpel, reducing the risk that a blood vessel might be nicked accidentally. Instead, the doctor uses a specially modified surgical clamp with sharpened points. One point makes a single puncture (so small it's invisible to the patient) through which the doctor reaches to snip each vas.

It takes about 10 minutes to cut and tie the vas ends with thread or tiny clips--40% faster than a traditional vasectomy. No stitches are needed, and the AVSC says minor complications occur in only 4 out of 1,000 cases, vs. 31 per 1,000 with the standard method.

Typically, the procedure costs $250 to $750. As is the case with female tubal ligation (commonly known as "having the tubes tied"), a microsurgeon may be able to reverse a vasectomy--but that requires a hospital stay and $5,000 or more. Although the no-scalpel procedure is less injurious than the older method, the odds on reversal are low. "So much depends on how the vas ends are closed and the health of the sperm," says Dr. Larry Davis of the University of Tennessee Medical Center.

Poor odds or not, reversals do occur, notes Thomas Berglund, a family practitioner in Portage, Mich. Among his 500 patients who underwent a no-scalpel vasectomy in the past year was one who'd had an earlier vasectomy reversed--and fathered a child with his new wife. "He said the second procedure was a breeze," Berglund says.Don Dunn


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