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British Journal of Urology (1996), 77, 585–586 B. A. HOLT and A .F . H IGG INSHinchingbrooke Hospital, Huntingdon, UK Objective To evaluate the associated morbidity and reduced in patients who underwent the MINS vasec- patient comfort of the ‘minimally invasive, no scalpel’ tomy (P<0.05) and the pain, bruising, swelling and complication rate were also less than in patients who Patients and methods Eighty-nine consecutive patients presenting for vasectomy underwent a MINS pro- Conclusions The MINS vasectomy is preferable to a cedure. Post-operatively, the pain experienced, recov- standard technique, reducing both patient morbidity ery time and complication rate were assessed using a and the complication rate. This is attributable to the postal questionnaire. The questionnaire was also used minimal dissection and reduced tissue handling to assess a group of historical controls who had required to expose and isolate the vas.
undergone a vasectomy using a standard technique.
Keywords Minimally invasive, no-scalpel, vasectomy.
Results The length of time to recovery was significantly ring-forceps with a blunt end (Femcare, UK) that can be clipped onto the vas through the scrotal skin, without Vasectomy is one of the commonest surgical procedures damaging the skin, and a mosquito forceps with a sharp performed, providing a simple, safe and efficient means tip (Fig. 1; Femcare, UK). An intradermal bleb of 2% of contraception. A new, ‘minimally invasive, no scalpel, plain lignocaine is used to anaesthetize the skin and a no suture’ (MINS) technique has been adopted in some perivasal block using 5 mL on each side provides excel- parts of the Far East and the USA, following its introduc- lent analgesia with minimal discomfort from infiltration.
tion in China (by Li Shun-Quiang) in 1974 [1]. This One vas, together with the overlying area of scrotal skin technique is claimed to reduce operative time and patient in the midline, is grasped in the ring forceps. The skin morbidity when compared with a standard vasectomy is pierced with the tip of the mosquito forceps to reveal the underlying vas and the vas hooked up into the A controlled study was performed to evaluate the wound using the mosquito forceps. The vas is then complication rate and patient comfort of this new re-grasped with the ring forceps (Fig. 2). The procedure is performed throughout by gentle blunt dissection. Fromthis point the procedure resembles a standard vasectomyin that a portion of the vas is excised and the free ends Eighty-nine consecutive, unselected patients presentingfor vasectomy underwent the MINS procedure. Bothprivate and National Health Service patients wereincluded. Each patient was asked to complete a question-naire detailing the time to recovery and the pain, swellingand bruising they had experienced, using visual ana-logue scales (VAS) (Appendix 1). Questionnaires werealso sent to 75 patients who had undergone vasectomyin the previous 6 months using a standard technique,to provide a group of historical controls.
The MINS vasectomy is performed using a modified Accepted for publication 5 December 1995*The results of this study were reported to the Summer meeting ofthe British Association of Urological Surgeons in 1992 Fig. 1. The instruments used in the minimally invasive vasectomy.
the amount of pain experienced during the procedurewith the amount they had expected, 86% of patients inthe MINS group had less pain than expected, comparedwith 52% in the standard vasectomy group. Only 2.7%of patients in the MINS group needed to visit theirgeneral practitioner post-operatively, compared with16.3% of the control group; both these results werestatistically significant (P<0.05, chi-squared test).
The MINS vasectomy had a lower complication ratethan did a standard vasectomy and was preferred by thepatients, causing less discomfort and a faster recovery.
Fig. 2. Operative view showing the vas being delivered into the The reduced swelling and bruising results from the wound using the mosquito forceps and held in the ring forceps.
minimal tissue dissection required to isolate and deliverthe vas. Continuing experience with the technique inChina, Thailand and in the USA has confirmed the Table 1 A comparison of the post-operative duration of the present findings that this is a safe and well accepted method of birth control [3]. We have now sterilized afurther 270 patients using the technique, which con- tinues to delight both patient and surgeon.
A.F.H. is grateful to Dr Mark Goldstein of New York and the Association for Voluntary Surgical Contraception for training in the technique. A video of the technique is available from: Christel Karner, Documentation HRP, World Health Organization, X11 Avenue Appia, 1211Geneva 27, Switzerland. Please specify British PALformat and the English language when ordering.
individual surgeon. The second vas is delivered similarlythrough the same wound. At the end of the procedure, contraction of the dartos muscle causes the skin wound 1 Shun-Quiang L. Vasal Sterilisation Techniques; Teaching to shrink to the size of a pinhole, which does not require material for the National Standard Workshop, Chongquing, China. Scientific and Technical Literature Press, 1988: 176 2 Apichart Nirapathpongpom, Huber DH, Krieger JN. No scalpel vasectomy at the Kings Birthday Vasectomy Festival.
3 Li S, Goldstein M, Zhu J, Huber G. Re: The no-scalpel Of patients who underwent the MINS or standard pro- cedure, 87% and 76%, respectively, replied to the ques-tionnaire. The time to recovery and the length of timeoff work were both significantly less for patients in the MINS group (Table 1; log-rank method, P=0.05). VAS B.A. Holt, FRCS, Senior House Officer (currently Urological scores for pain, bruising and swelling were also lower in Registrar in the South Wales training scheme).
the MINS group, although the differences were not A.F. Higgins, FRCS, Consultant Urologist.
statistically significant for bruising when a Mann– Correspondence: Mr A.F. Higgins, Hinchingbrooke Hospital, Whitney U-test was applied. When asked to compare 1996 British Journal of Urology 77, 585–586

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