title: Percutaneous vasectomy: a simple modification eliminates the steep learning curve of no-scalpel vasectomy.
abstract: OBJECTIVE
  We report a simplified method to avoid the most difficult step of no-scalpel vasectomy, while maintaining its minimally invasive advantages.
  
  
  METHODS
  Using the no-scalpel vasectomy instruments in percutaneous fashion we perform vasectomy in the office setting without fixation of the vas to skin using the ring clamp. The sharp no-scalpel hemostat punctures the skin. The vas is then grasped with the ringed instrument instead of piercing the vas and performing the supination maneuver, as described for no-scalpel vasectomy.
  
  
  RESULTS
  Percutaneous vasectomy was performed in 573 men by a single surgeon. In the 35 consecutive cases recently reviewed average operative time was 9.3 minutes with an additional 67 seconds added when a resident performed the procedure on 1 side in 15 cases. As determined by the knuckle of vas pulled through a puncture, average incisional length was 8.4 mm. Patients reported complete recovery in an average of 8.9 days. No major complications occurred. A single case of recanalization (0.17%) was successfully corrected by repeat percutaneous vasectomy.
  
  
  CONCLUSIONS
  Percutaneous vasectomy is a minimally invasive option for permanent male sterilization that avoids the difficult aspects of no-scalpel vasectomy.
authors.affiliation: Glickman Urological Institute, Cleveland Clinic Foundation, Ohio, USA.
authors.forename: J Stephen
authors.initials: JS
authors.lastname: Jones
mesh_terms: D000556:Ambulatory Surgical Procedures; D006801:Humans; D007396:Internship and Residency; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D013525:Surgical Instruments; D013996:Time and Motion Studies; D014572:Urology / Q000193:education; D014659:Vasectomy / Q000193:education / Q000295:instrumentation*