title: Use of surgical clips prevents suture slippage when ligating folded vas deferens during vasectomy.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Urology, Medical College of Georgia, Augusta, Georgia, USA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Hadj-Moussa
authors.forename: James A
authors.initials: JA
authors.lastname: Brown
mesh_terms: D006801:Humans; D008026:Ligation; D008297:Male; D013525:Surgical Instruments; D013537:Sutures; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods; D014649:Vas Deferens; D014659:Vasectomy / Q000295:instrumentation*