• Lynley A Cook, Asha Pun, Maria F Gallo, Laureen M Lopez, and Huib A A M Van Vliet.
• Public Health and General Practice, University of Otago, Box 4345, Christchurch, Canterbury, New Zealand, 8140.
• Cochrane Db Syst Rev. 2014 Mar 30; 2014 (3): CD004112CD004112.

BackgroundCurrently, the two most common surgical techniques for approaching the vas during vasectomy are the incisional method and the no-scalpel technique. Whereas the conventional incisional technique involves the use of a scalpel to make one or two incisions, the no-scalpel technique uses a sharp-pointed, forceps-like instrument to puncture the skin. The no-scalpel technique aims to reduce adverse events, especially bleeding, bruising, hematoma, infection and pain and to shorten the operating time.ObjectivesThe objective of this review was to compare the effectiveness, safety, and acceptability of the incisional versus no-scalpel approach to the vas.Search MethodsIn February 2014, we searched the computerized databases of CENTRAL, MEDLINE, POPLINE and LILACS. We looked for recent clinical trials in ClinicalTrials.gov and the International Clinical Trials Registry Platform. Previous searches also included in EMBASE. For the initial review, we searched the reference lists of relevant articles and book chapters.Selection CriteriaRandomized controlled trials and controlled clinical trials were included in this review. No language restrictions were placed on the reporting of the trials.Data Collection And AnalysisWe assessed all titles and abstracts located in the literature searches and two authors independently extracted data from the articles identified for inclusion. Outcome measures included safety, acceptability, operating time, contraceptive efficacy, and discontinuation. We calculated Peto odds ratios (OR) with 95% confidence intervals (CI) for the dichotomous variables.Main ResultsTwo randomized controlled trials evaluated the no-scalpel technique and differed in their findings. The larger trial demonstrated less perioperative bleeding (OR 0.49; 95% CI 0.27 to 0.89) and pain during surgery (OR 0.75; 95% CI 0.61 to 0.93), scrotal pain (OR 0.63; 95% 0.50 to 0.80), and incisional infection (OR 0.21; 95% CI 0.06 to 0.78) during follow up than the standard incisional group. Both studies found less hematoma with the no-scalpel technique (OR 0.23; 95% CI 0.15 to 0.36). Operations using the no-scalpel approach were faster and had a quicker resumption of sexual activity. The smaller study did not find these differences; however, the study could have failed to detect differences due to a small sample size as well as a high loss to follow up. Neither trial found differences in vasectomy effectiveness between the two approaches to the vas.Authors' ConclusionsThe no-scalpel approach to the vas resulted in less bleeding, hematoma, infection, and pain as well as a shorter operation time than the traditional incision technique. No difference in effectiveness was found between the two approaches.

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