Permanent methods of family planning

The Vasectomy Procedure

Vasectomy is a safe, simple and effective birth control method.

One of the most common and popular means for contraception around the world is vasectomy – a brief, surgical procedure used for male sterilization. It is a popular means of birth control for couples that have decided that their family is complete. It is nearly 100% effective and is intended to be permanent.
The procedure starts with the administration of local anesthesia, to numb the genitals. This allows the patient to remain awake and alert during the procedure, but unable to feel the surgery. In some cases, a new technology, the needleless injection, is used to administer the anesthetic in this sensitive area. Your doctor may or may not have this new system available for use during surgery.
Once the genital area is numbed, the area will be shaved and the skin prepared with a solution that kills bacteria on the surface of the skin. Once the solution dries, the surgery begins with 1 or 2 half-inch long incisions on the underside of the scrotum. The vas deferens, the cord that carries sperm, is then located and either cut and tied off or cut and cauterized. Research shows that the use of cautery is the most effective, as it prevents the vas deferens from healing back together. 


The incision is then closed with sutures, which can be removed at the surgeon’s office in a week to ten days.

A vasectomy is chosen by over 600,000 American men annually, and as many as 30 million men worldwide. The vasectomy procedure is uncomplicated, is commonly performed in a doctor’s office and usually takes about 15 to 20 minutes.

All about vasectomy.

The simplest and safest vasectomy method is the No-Scalpel Vasectomy (NSV), which, as the name suggests, requires no scalpel, no incisions (only two tiny punctures in the skin) and no sutures. It is performed with a local anesthetic to numb the area. The No-Scalpel Vasectomy is rapidly becoming the procedure of choice among patients and is also favored by many doctors.

Urologists perform most vasectomies, although up to 30 % are performed each year by family practitioners, depending on the location. Costs range from $500 to over $1,000 and is reimbursed by many health insurance programs.

In Summary:

• A vasectomy is a safe and simple procedure.
• It is one of the most common means for permanent contraception.
• The procedure is over 99 % effective and intended to be permanent.
• The "No-Scalpel Vasectomy" method is popular with patients and doctors.
• It is usually performed in the doctor's office in less than 30 minutes.
• Urologists and general practitioners perform vasectomies.

The cost is low and is often reimbursed by health insurance.

Tubectomy

Tubal Sterilization is a permanent method of contraception where the fallopian tubes are blocked so that the ova or eggs are prevented from traveling to the uterus from the ovary.

general surgeons

and laparoscopic surgeons perform tubectomy.
The Fallopian Tubes are two in number and are attached on either side of the uterus at one end and the other end is open in the abdomen. The length of each Fallopian tube is about 10cm.When the ovum or egg is released from the ovary, it is picked up by Fallopian tube through which it moves into the uterus. If sperms are present in the Fallopian tubes, the ovum is fertilized and the resulting embryo is transmitted to the uterus where it is embedded. In short, we can say that Fallopian tubes are channels through which the eggs from the ovaries travel to the uterus. In Tubectomy the tubes are blocked or divided to prevent the eggs from entering the uterus. This prevents any future pregnancies to occur after the surgical procedure. 

The preferred method that is used commonly is to use a laparoscopic approach to identify the fallopian tubes on both the sides and apply plastic clips.

There are different surgical approaches for the tubal sterilization operations are

1. Laparoscopy
2. Microlaparoscopy
3. Laparotomy (concurrent with cesarean delivery)
4. Minilaparotomy
5. Hysteroscopy
6. Vaginal approaches.

Laparoscopy

The most popular is using a laparoscope; where the patient has just a couple of small scars and is discharged home the same day.

If laparoscopy is not available an open surgical operation may be required. Here the tubes are completely divided and a section is excised.

Local anesthesia is used for more than 75% of sterilizations worldwide. Laparoscopic sterilization in performed under general anesthesia. Spinal anesthesia is preferred for procedures done immediately after delivery of the baby

Local anesthesia is the standard for the hysteroscopic approach, and it may be supplemented by oral or IV sedation if needed.

The actual procedure is done in an operating room, either in a hospital or a surgical center.

Currently, Laparoscopy is the most popular method of female sterilization in nonpregnant women. It is performed under General Anesthesia. The surgery takes about half an hour.

1. In the Laparoscopy procedure, the abdomen is filled with carbon dioxide gas by introducing a needle so that the abdominal wall balloons away from the uterus and tubes.

2. The surgeon makes a small cut just below the navel and inserts a laparoscope, a small telescope-like instrument.

3. A second incision is made just above the pubic hairline to allow the entrance of another small instrument that can help with closure of the fallopian tubes.

4. Usually Falope rings or Filshie clips are placed on the fallopian tubes to block the tubes. Sometimes the tubes are cut and clipped

5. The skin incision is then closed with one stitch or a tape. The patient may feel well enough to go home from the outpatient surgery center in a few hours.

Advantages include small incisions, rapid access to the fallopian tubes and rapid recovery.

Disadvantages include the need for general anesthesia, the risks of injury to internal organs with needle insufflations. Difficulty associated with Laparoscopy in patients who are obese.

Micro-laparoscopy
Micro-laparoscopy involves use of micro endoscopes of smaller diameter with 5 to 7 mm suprapubic incisions being made. This surgery is possible because of improved technology in light transmission and fiber optic bundles.

There are some theoretical advantages such as even smaller scars, less pain, less cost, and faster patient recovery. However the difference is so marginal that it has never become very popular despite being available for almost 20 years.

Contraindications

1. The patient should make the request herself, be of sound mind, and not act under external duress.

2. During delivery of the baby some women opt for sterilization; however this should be deferred if maternal or infant complications are anticipated.

3. Surgery is contraindicated in patients with active infections like Pelvic Inflammatory Disease (PID)

4. The laparoscopic approach is also contraindicated in patients with severe heart or lung problems.

5. Surgery is deferred in patients with suspected pregnancy