Comparison of midazolam and butorphanol combined with ketamine or dexmedetomidine for chemical restraint in howler monkeys (Alouatta guariba clamitans) for vasectomy.

BACKGROUND: This study evaluated and compared cardiorespiratory and blood gas parameters, as well as sedation, analgesia and recovery of two protocols: ketamine (10 mg/kg) or dexmedetomidine (10 µg/kg), with midazolam (0.5 mg/kg) and butorphanol (0.3 mg/kg), IM (KBM and DBM, respectively) in brown howler monkeys (Alouatta guariba clamitans). MATERIAL AND METHODS: Twelve brown howler monkeys were selected in two groups and evaluated for cardiorespiratory parameters and sedation, from 5-30 minutes after latency. Blood gas and arterial lactate were taken at 5 and 30 minutes. In the end, time and quality of recovery were evaluated. RESULTS: The HR in DBM group was significantly lower at all times. The sedation score was higher in DBM. Recovery in DBM was faster. All animals had moderate hypoxaemia. CONCLUSION: Both protocols produce satisfactory anaesthesia and analgesia, but DBM provides deeper sedation with faster recovery. Oxygen supplementation is recommended in both due to hypoxaemia.

Vasectomy in Mouse Model Using Electrosurgery Machine.

Vasectomy in laboratory animals is a crucial step in the production of surrogate female mice. The surrogate mothers play a key role in successful embryo transfer, most important steps for the production of transgenic animal models, investigation of the preimplantation embryo development, and revitalization of cryopreserved strains. Abdominal and scrotal surgeries are common surgical procedures used in routine veterinary practice to produce vasectomized males. Two different surgical practice, namely electrosurgery and cold surgical practice, have been used as common techniques in operating rooms. Based on current knowledge, there is no published “technical note” as a detailed and step by step guideline to describe vasectomy using an electrosurgery machine (i.e., Bovie machine) in laboratory animal research and breeding facilities.The common problem during the laboratory animal surgery would be animal mortalities as a consequence of profound bleeding. The use of Bovie machine leads to the prevention of profound bleeding during the surgical practice.

Vasectomy with vessel sealing device: comparison of different diameters.

OBJECTIVES: Vasectomy is a popular and effective male surgical contraceptive method. Different techniques have been proposed to reduce failure rates and complications. In this study, we sought to compare vas deferens occlusion rates using both standard occlusion techniques and LigaSure (LSVS) for vasectomy. MATERIAL AND METHODS: A total of nine patients underwent open radical retropubic prostatectomy at our institution. During the procedure, a total of 125 fresh vas deferens samples were obtained and divided into four groups as follows: Group 1: ligation (n = 22), Group 2; ligation and electrocauterization (n = 18), Group 3; 5 mm LSVS (n = 44), Group 4; 10 mm LSVS (n = 41). All specimens were harvested during surgery and subsequent histopathological assessments were performed to assess the luminal status of the vas deferens. RESULTS: Histopathological evaluation revealed that the majority of vas lumens with LSVS (79.5% of Group 3 and 89.4% of Group 4) were totally occluded. With standard techniques, however, the majority of vas lumens (86.4 and 77.8% of Groups 1 and 2, respectively) maintained a tiny patency. CONCLUSIONS: On histopathological review, the application of LSVS resulted in better occlusion rates, compared to standard ligation methods. These findings suggest a higher occlusive role for LSVS for vasectomy. Further clinical studies are needed to confirm the clinical efficacy and safety of this technique.

Is Endoscopic Vasectomy Just a Dream: An ex vivo Study on Feasibility and Reliability of Endoluminal Occlusion of Porcine Vas Deferens.

INTRODUCTION AND AIM: Surgical vasectomy remains the gold standard for fertility control in men. Endoluminal occlusion of the seminal ducts, thus avoiding an external incision, may become an appealing alternative to this approach. As our group has shown, nontraumatic endoscopic inspection of the seminal ducts is feasible in the human cadaver. We investigated the feasibility and reliability of occlusion using several commercially available medical sealing agents in the porcine vas deferens (VD). METHODS AND MAIN OUTCOME MEASURES: Tests were conducted using 25 porcine spermatic ducts (10 cm length) ex vivo. The explanted specimens were fixed and cannulated using the Seldinger technique. We administered 5 different agents (n-butyle-2-cyanoacrylate, n-butyle-2-cyanoacrylate in combination with a platinum vascular coil, Tissucol Duo S®, Gelita Spon® and AFP Plug®) endoluminally. Tightness was evaluated after 5, 15, 60, 360, 720, and 1,440 min for each of the five grades, respectively, using a solution of methylene blue and saline injected under controlled pressure of 300 mm Hg followed by histological examination. RESULTS: All agents were administered into the porcine seminal ducts (4 out of 5 via a ureteric catheter). Gelita Spon® and Tissucol Duo S® did not occlude the lumen sufficiently, whereas n-butyle-2-cyanoacrylate, n-butyle-2-cyanoacrylate in combination with coil, Tissucol Duo and AFP Plug® performed satisfactorily. In particular, cyanoacrylate combined with a coil was able to close the seminal duct tightly and for a long time. Histological findings confirmed this sealant's gapless adhesion. AFP Plug® application revealed similarly good results. However, its form needs to be optimized to ensure its suitability for endoscopic use. CONCLUSION: Various developments regarding minimally invasive fertility control methods have been underway for decades. Further miniaturization of endoscopy and novel materials may pave the way for endoscopic fertility control in males in the future. We demonstrated the potential of commercially available medical sealing agents to reliably occlude the porcine VD.

Scalpel versus no-scalpel incision for vasectomy.

BACKGROUND: Currently, the two most common surgical techniques for approaching the vas during vasectomy are the incisional method and the no-scalpel technique. Whereas the conventional incisional technique involves the use of a scalpel to make one or two incisions, the no-scalpel technique uses a sharp-pointed, forceps-like instrument to puncture the skin. The no-scalpel technique aims to reduce adverse events, especially bleeding, bruising, hematoma, infection and pain and to shorten the operating time. OBJECTIVES: The objective of this review was to compare the effectiveness, safety, and acceptability of the incisional versus no-scalpel approach to the vas. SEARCH METHODS: In February 2014, we searched the computerized databases of CENTRAL, MEDLINE, POPLINE and LILACS. We looked for recent clinical trials in ClinicalTrials.gov and the International Clinical Trials Registry Platform. Previous searches also included in EMBASE. For the initial review, we searched the reference lists of relevant articles and book chapters. SELECTION CRITERIA: Randomized controlled trials and controlled clinical trials were included in this review. No language restrictions were placed on the reporting of the trials. DATA COLLECTION AND ANALYSIS: We assessed all titles and abstracts located in the literature searches and two authors independently extracted data from the articles identified for inclusion. Outcome measures included safety, acceptability, operating time, contraceptive efficacy, and discontinuation. We calculated Peto odds ratios (OR) with 95% confidence intervals (CI) for the dichotomous variables. MAIN RESULTS: Two randomized controlled trials evaluated the no-scalpel technique and differed in their findings. The larger trial demonstrated less perioperative bleeding (OR 0.49; 95% CI 0.27 to 0.89) and pain during surgery (OR 0.75; 95% CI 0.61 to 0.93), scrotal pain (OR 0.63; 95% 0.50 to 0.80), and incisional infection (OR 0.21; 95% CI 0.06 to 0.78) during follow up than the standard incisional group. Both studies found less hematoma with the no-scalpel technique (OR 0.23; 95% CI 0.15 to 0.36). Operations using the no-scalpel approach were faster and had a quicker resumption of sexual activity. The smaller study did not find these differences; however, the study could have failed to detect differences due to a small sample size as well as a high loss to follow up. Neither trial found differences in vasectomy effectiveness between the two approaches to the vas. AUTHORS' CONCLUSIONS: The no-scalpel approach to the vas resulted in less bleeding, hematoma, infection, and pain as well as a shorter operation time than the traditional incision technique. No difference in effectiveness was found between the two approaches.

Common questions about vasectomy.

Vasectomy offers a safe, effective, and permanent method of male contraception, with an overall failure rate of less than 1% in pooled studies. Men older than 30 years in a stable, committed relationship appear to be the best candidates for vasectomy. The no-scalpel technique reduces operative complications, shortens operative time, and hastens resumption of sexual activity. Use of a jet injector instead of a needle to provide local anesthesia (no-needle vasectomy) may reduce pain. Bleeding and infection are short-term complications of vasectomy; long-term complications include sperm granuloma and postvasectomy pain syndrome. One postvasectomy semen analysis demonstrating azoospermia performed after three months and 20 ejaculations is sufficient to establish sterility. Vasectomy reversal is more likely to be successful if performed less than 15 years after vasectomy and in men whose female partner is younger than 40 years.

Vasectomy occlusion technique combining thermal cautery and fascial interposition.

INTRODUCTION: Recent research on vasectomy shows that combining cautery and fascial interposition (FI) achieves the most effective occlusion of the vas and minimizes the risk of failure. We present a technique that combines cautery and FI and is suitable for low-resource settings. SURGICAL TECHNIQUE: The surgical technique consists of 1) exposing the vas with the no-scalpel approach; 2) cauterizing the epithelium of lumen of the vas using a portable battery-powered cautery device; 3) performing FI by grasping internal spermatic fascia and applying a free tie with suture material on the fascia to cover the prostatic stump of the vas and separate the two ends of the cut vas; and 4) excising a small 0.5 to 1 cm of the testicular stump. COMMENTS: To maximize vasectomy effectiveness, vasectomy providers should consider learning thermal cautery and FI to occlude vas deferens.

Vasectomy occlusion technique combining thermal cautery and fascial interposition

INTRODUCTION: Recent research on vasectomy shows that combining cautery and fascial interposition (FI) achieves the most effective occlusion of the vas and minimizes the risk of failure. We present a technique that combines cautery and FI and is suitable for low-resource settings. SURGICAL TECHNIQUE: The surgical technique consists of 1) exposing the vas with the no-scalpel approach; 2) cauterizing the epithelium of lumen of the vas using a portable battery-powered cautery device; 3) performing FI by grasping internal spermatic fascia and applying a free tie with suture material on the fascia to cover the prostatic stump of the vas and separate the two ends of the cut vas; and 4) excising a small 0.5 to 1 cm of the testicular stump. COMMENTS: To maximize vasectomy effectiveness, vasectomy providers should consider learning thermal cautery and FI to occlude vas deferens.

Práctica de la vasectomía en un municipio urbano. Consideraciones practicas para el seguimiento / The performance of vasectomy in an urban municipality. Practical considerations for follow-up

OBJECTIVES: To establish an adequate follow-up protocol based on time to azoospermia achievement after vasectomy. Also, to review the rate of complications in our setting.METHODS: Retrospective analysis of 391 men who underwent vasectomy. Follow-up was performed by means of semen analysis 6 months after surgery, and then every 3 months until azoospermia was achieved. Data of visits to the emergency unit at our centre were obtained within the first 30 postoperative days.RESULTS: During follow-up 567 semen analysis were performed. From 391 vasectomy interventions, 275 had at least one semen sample available and valid for processing. After the first 6 months from surgery, 41.1% men still presented nonmotile rare sperm in semen analysis, 9.7% after 9 months, and 4.7% after 12 months. If semen analysis was postponed from 6 to 9 months after surgery, a total yearly saving of 6,153.23 Euro would be observed in our setting, but with the drawback of delaying the diagnosis of azoospermia in nearly 60% of men. Overall complication rate was 3.1% (only one man required hospital admittance and re-intervention). No statistical difference was observed in operative time with regard to the presence or absence of urological complications.CONCLUSIONS: The percentage of men not achieving azoospermia 6 months after surgery is notorious. Vasectomy practice in our setting seems to be reliable and safe, with a limited rate of complications(AU)

OBJETIVO: Establecer un protocolo de seguimiento adecuado basado en el tiempo necesario para conseguir la azoospermia tras la realización de vasectomía, y revisar la frecuencia de complicaciones en nuestro entorno.MÉTODOS: Análisis retrospectivo de 391 vasectomías. Seguimiento mediante seminograma postvasectomía a los 6 meses de la intervención, y posteriormente con periodicidad trimestral hasta conseguir la azoospermia. Registro de las frecuentaciones en el Servicio de Urgencia de nuestro centro dentro de los 30 días del postoperatorio.RESULTADOS: Durante el seguimiento se han llevado a cabo 567 seminogramas. De las 391 vasectomías realizadas, 275 presentaron al menos una muestra válida para su procesamiento. Al finalizar los 6 meses tras la cirugía un 41,1% presentaron espermatozoides aislados inmóviles en el seminograma, 9,7% tras los 9 meses, y 4,7% al finalizar los 12 meses. El retrasar el primer seminograma de los 6 a los 9 meses tras la intervención supondría un ahorro de 6153,23 Euros anuales en nuestro entorno, con la desventaja de diferir el alta de casi el 60% de los pacientes intervenidos. La tasa de complicaciones se situó en el 3,1% (sólo un paciente requirió reintervención e ingreso). No existió diferencia significativa en cuanto al tiempo operatorio en los pacientes con o sin complicación urológica.CONCLUSIONES: La proporción de pacientes que no alcanzan la azoospermia tras los 6 meses postcirugía es notable. La práctica de la vasectomía parece fiable y relativamente segura en nuestro entorno, con una contenida tasa de complicaciones

[No-scalpel vasectomy. Profile of acceptance and results]. / Vasectomía sin bisturí. Perfil del usuario y resultados.

BACKGROUND: Men have few effective methods for birth control. The surgical method vasectomy is highly safe and effective, although in Mexico represents only 2.4% of all contraceptive methods used. OBJECTIVE: To determine the characteristics, complications and results of the men who requested and underwent no-scalpel vasectomy in the Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, in México. MATERIAL AND METHOD: Retrospective cohort study with data of clinical records of men who underwent no-scalpel vasectomy from 2003 to 2007. Sociodemographic and clinical variables, and complications reported as well as espermatobioscopy data were included. Descriptive analysis was performed of different variables and chi squared test between proportions. RESULTS: A total of 596 no-scalpel vasectomies were performed. The average age was 36.5 years and 13.4 of schooling, 86.9% were married with 9.6 years of union. Socioeconomic status was as follows: medium (25%), middle high (20.1%), and high (24.7%). The 94.3% of men requested the no-scalpel vasectomy because of satisfied fertility and 5.7% by morbidity in his couple. The complications were as follows: epididymitis (2.2%), mild haematoma (1.5%) and contact dermatitis (0.2%). The surgical complications were significantly more frequent for the group with varicocele compared with the normal men group (p < 0.05). Azoospermia was achieved in 99.1% of men at 18 weeks after the no-scalpel vasectomy. Early recanalization occurred in 0.5% of men. There were no pregnancies. CONCLUSIONS: The profile of men who requested no-scalpel vasectomy was in a great proportion healthy, in the fourth decade of life, with high school or greater, satisfied fertility and high socioeconomic status. No-scalpel vasectomy is a method of fertility planning very effective with low morbidity.

Use of surgical clips prevents suture slippage when ligating folded vas deferens during vasectomy.

OBJECTIVE: We describe a technique of surgical clip placement, which prevents slippage when ligating the folded vas deferens during vasectomy. METHODS: We utilized this technique in 25 consecutive vasectomy procedures. After isolating the vas, two mosquito clamps are placed approximately 2 cm-3 cm apart and a small 5 mm-10 mm section of full thickness vas is removed. The lumen of each cut end is cauterized. Surgical clips (Ethicon Ligaclip Extra LS-200, Medium) are placed at approximately 2 mm, 3 mm and 15 mm (on the opposite side of the hemostat) from each cut end. By rotating the hemostat, the vas is folded on itself and a 3-0 or 4-0 chromic suture is placed between the two proximal clips and distal to the third clip. The hemostat is carefully removed and the vas gently ligated. RESULTS: A single surgeon noted no instances of suture slippage in 25 consecutive vasectomies. All patients underwent postoperative semen analysis that showed azoospermia. CONCLUSION: Placement of the ligating suture between two proximal clips and past a third distal clip prevents suture slippage when ligating the folded end of the vas deferens during vasectomy.

Minimally invasive vas surgery using a newly designed double-ringed clamp.

INTRODUCTION: We have recently designed a novel surgical instrument, a double-ringed clamp (Moon's clamp), with which the vas deferens can be located and isolated both simply and safely while minimizing unnecessary injury to the surrounding tissue. MATERIALS AND METHODS: With the use of the Moon's clamp, we successfully performed 1,140 cases of simplified, minimally invasive vasectomy and 216 cases of mini-incision vasectomy reversals (vasovasostomies) without any significant complications. CONCLUSION: This surgical technique, using Moon's clamp, may be effective in reducing the operative time, the postoperative complications and the recovery time after different types of vas surgeries, such as vasectomy or vasectomy reversal.

A novel modification of no-scalpel vasectomy: a preliminary report.

OBJECTIVE: To present a novel technique of no-scalpel vasectomy (NSV) that has the potential to decrease the failure rate. PATIENTS AND METHODS: From 2006 until 2008 vasectomy was performed by ligating head-to-head and tail-to-tail the cut ends of the vasa deferentia. The outcome of the procedure was assessed by three semen analyses, the first two of which were carried out three months postoperatively and the third one at the end of the study period. SPSS version 13 was used to analyse data. RESULTS: Fifty-four patients participated in this study. The operating time amounted to an average of 16 minutes. The mean duration of follow-up was 17.7 +/- 6.69 months (range: 12-34). The outcome of the procedure overall was excellent with a minimum of complications. CONCLUSION: Vasal head-to-head and tail-to-tail ligation in NSV shows promise as a safe and effective sterilisation procedure.

Scalpel versus no-scalpel incision for vasectomy.

BACKGROUND: Currently, the two most common surgical techniques for approaching the vas during vasectomy are the incisional method and the no-scalpel technique. Whereas the conventional incisional technique involves the use of a scalpel to make one or two incisions, the no-scalpel technique uses a sharp-pointed, forceps-like instrument to puncture the skin. The no-scalpel technique aims to reduce adverse events, especially bleeding, bruising, hematoma, infection and pain and to shorten the operating time. OBJECTIVES: The objective of this review was to compare the effectiveness, safety, and acceptability of the incisional versus no-scalpel approach to the vas. SEARCH STRATEGY: We searched the computerized databases of CENTRAL, MEDLINE, EMBASE, POPLINE and LILACS in May 2006. In addition, we searched the reference lists of relevant articles and book chapters. SELECTION CRITERIA: Randomized controlled trials and controlled clinical trials were included in this review. No language restrictions were placed on the reporting of the trials. DATA COLLECTION AND ANALYSIS: We assessed all titles and abstracts located in the literature searches and two authors independently extracted data from the articles identified for inclusion. Outcome measures included safety, acceptability, operating time, contraceptive efficacy, and discontinuation. MAIN RESULTS: Two randomized controlled trials evaluated the no-scalpel technique and differed in their findings. The larger trial demonstrated less perioperative bleeding (Odds ratio (OR) 0.49; 95% Confidence Interval (CI) 0.27 to 0.89) and pain during surgery (OR 0.75; 95% CI 0.61 to 0.93), scrotal pain (OR 0.63; 95% 0.50 to 0.80), and incisional infection (OR 0.21; 95% CI 0.06 to 0.78) during follow up than the standard incisional group. Both studies found less hematoma with the no-scalpel technique (OR 0.23; 95% CI 0.15 to 0.36). Operations using the no-scalpel approach were faster and had a quicker resumption of sexual activity. The smaller study did not find these differences; however, the study could have failed to detect differences due to a small sample size as well as a high loss to follow up. Neither trial found differences in vasectomy effectiveness between the two approaches to the vas. AUTHORS' CONCLUSIONS: The no-scalpel approach to the vas resulted in less bleeding, hematoma, infection, and pain as well as a shorter operation time than the traditional incision technique. No difference in effectiveness was found between the two approaches.

Persistent motile sperm after ligation band vasectomy.

PURPOSE: We evaluated the efficacy and mechanism of failure in a small case series of VasClip vasectomies. MATERIALS AND METHODS: Between September 2003 and March 2004, 8 patients underwent elective vasectomy using the VasClip ligation band. Microscopic semen analysis was done a minimum of 4 weeks postoperatively and after at least 15 ejaculations. The number of sperm and motility were quantified in 15 or more high power fields. Successful vasectomy was defined as 2 consecutive postoperative unspun semen analyses containing no sperm. Patients with failed vasectomy underwent bilateral surgical removal of the vas deferens segments containing the ligation band for gross and histological analysis. RESULTS: Six of 8 patients (75%) were deemed azoospermic after 2 semen analyses at a mean followup of 7 and 11 weeks postoperatively, respectively. Two of 8 patients (25%) had semen analyses containing multiple motile sperm after vasectomy. In the 2 failed cases 1 side was patent, as demonstrated by vasal cannulation and irrigation with dilute methylene blue despite a well positioned, intact and secure ligation band. Histological analysis showed extravasation and sperm granuloma on the patent side. CONCLUSIONS: The VasClip was found to fail at an unexpectedly high rate. Pathological analysis suggests sperm extravasation and fistula tract formation as the mechanism. One failure resulted in an unwanted pregnancy, which demonstrates the need for patient counseling regarding postoperative followup.

No scalpel vasectomy--an overview.

Male sterilisation is less popular because of fear of loss of virility and loss of physical strength. No scalpel vasectomy is a surgical attempt to reduce complications and thereby allays the fear in the minds of the couples. Despite the introduction of the advanced technique the acceptance of male sterilisation has not gone up. Though with aggressive IEC compaign has failed to produce the desired result, but a camp based approach was successfully adopted in some states of India. Technique of no scalpel vasectomy has been summarised in the article with diagrams. Some postoperative instructions should be given to the client after discharge. No scalpel vasectomy is the gold standard for vasectomy today. Training is mandatory for experienced surgeons. Government of India funds and supports both the training and service activity.

No scalpel vasectomy advocacy and community mobilisation--a personal experience.

The so called myths and taboos among the people of India are obstactes controlling population explosion and thereby the nation is being handicapped with economic development. To propagate awareness and information, the NSV Resource Center took up organising mega camps for the acceptance of NSV as the method of family planning and male participation. The awareness material has been developed to bring forth total sociocultural transformation through development of intense desire, strong determination, effective management and inclusion of a zeal of perpetual efforts both among the promoters and acceptors. The information modules have been developed to suit the requirements of various vehicles through which the message has to be spread. Awareness messages are generated through the inputs from sociocultural, economic, ethical, hygienic and administrative acumen. The materials prepared are disseminated through display hoardings, wall writings, distribution of pamphlets, audiovisual clips, face to face counselling, etc. Communication technology serves mobilising and educating people, especially rural populace. Some steps are suggested to reach remotest villages which are elaborated. Counselling is an essential part of motivation to the client. During the last 5 years a significant surge has been noticed in terms of access to new communication technologies. This may be employed to successfully implement the family planning programme.

A new look at male sterilisation (no-scalpel vasectomy) in Orissa.

The author looks into the comparatively newly introduced procedure of 'no-scalpal vasectomy' as it is practiced in Orissa, compares it with the conventional vasectomy and other methods of sterilisation in terms of advantages and gives the outline of the NSV procedure along with postoperative advice in a brief manner.