Basic Anatomy
Sperms are produced and stored in the testicles. During sexual intercourse at the time of male orgasm, the sperms are rapidly transported from the testicle and are ejaculated. The thin tube that transports the sperm from the testicle is called the vas deferens. Each testicle has only one vas deferens.
During the vasectomy procedure, the vas deferens from each testicle is cut through and one end (abdominal end) tied off. This prevents any future transport of sperms away from the testicle. In other words, sperms are still being produced but they have no way of getting from the testicle to “the outside”, therefore rendering the male infertile (sterile).

Vasectomy
The Vasectomy Procedure Step-by-Step
The majority of men who opt to have a vasectomy do so between the ages of 25 and 45 years. These are the years of career building and productivity. With this in mind, I have optimized the circumstances and technique of the operation to hopefully ensure a relaxed and stress-free operation day and rapid post-operative recovery.
If you opted to have the vasectomy performed under local anaesthesia, there is no need to be nil by mouth from the previous evening. You need to arrive at my consulting rooms at the scheduled time, after which you will be prepared and the vasectomy be performed as follows:
Step 1: Local anaesthesia
A very fine needle is used to inject a quick-acting local anaesthetic into the area that will be operated on. The local anaesthetic penetrates into the skin and underlying structures (vas deferens), achieving a complete numbing effect within about 1-3 minutes. Using a fine needle and careful technique of local anaesthetic injection ensures minimal tissue trauma, which helps to decrease post-operative pain and complications while also helping to speed up recovery.

Administration of local anaesthetic to numb the area
Step 2: Access to the vas deferens – NO SCALPEL
After making sure that the area has been completely anaesthetized, a small, fine-tipped surgical forceps is used to stretch open the skin overlying the vas deferens.
The opening in the skin is then dilated (opened up) a few millimeters to allow a segment of the vas deferens to be pulled through the opening – a special forceps with a loop at the tip is used for this purpose.

Piercing skin overlying vas deferens

Opening up skin overlying vas deferens

Grabbing vas deferens with ring retractor

Pulling the vas deferens through small skin opening
Step 3: Removing a segment of vas and tying off one end – OPEN ENDED
With a small piece of vas deferens now pulled through the skin opening, a 1cm segment is removed cut out. This leaves 2 open ends of vas deferens:
The abdominal end is closed off. This is to decrease the risk of the 2 ends somehow re-connecting on their own at a later stage. Additionally, I stitch a small piece of muscle tissue that is normally situated next to the vas over the tied-off end – this technique (called “fascia interposition”) has been proven to decrease the risk of vasectomy failure even more. Furthermore, the inside (lumen) of the abdominal end of the vas deferens is also thermally disrupted (called “mucosal cautery”) in order to prevent it from ever opening up and re-connecting. Performing these measures (fascia interposition, mucosal cautery) ensures a very high success rate.

Removing vas segment, tying of abdominal end. Testicular end left opens
The testicular end of the vas deferens is not closed with a stitch – it is left open (“Open-ended Vasectomy”). Leaving this piece open has been proven to reduce the risk of “Post Vasectomy Pain Syndrome”, which is a long-term painful and extremely bothersome reality for about 5% of men who are subjected to the traditional method of vasectomy. International research has further shown that open-ended vasectomy significantly improves the chances of successfully reversing the vasectomy, should a patient change their mind and wish to have more children at a later stage.

Fascia interposition
It is important to note that open-ended vasectomy (combined with fascia interposition and mucosal cautery of the abdominal end) is just as effective in establishing male sterility as a vasectomy where both ends of the vas are tied off. So no compromise is made on the efficacy of the vasectomy by leaving one end open – it just has the added advantages mentioned above.
Steps 1 to 3 should take altogether about 25 minutes to complete on both sides (left and right testicles). No stitches are needed to close the “no scalpel” openings in the scrotal skin – a small plaster is simply placed over each wound.
After the procedure and once my nursing staff has ensured that you are feeling relaxed and not in pain, you’ll be allowed to go home.