Vasectomy has long been a safe, effective, easy-to-perform method of contraception for men. Throughout its history, people have been trying to find ways to make the procedure simpler Dr. Li Shunqiang developed the no-scalpel vasectomy technique, and in 1986, EngenderHealth in cooperation with Dr. Li, began to introduce the technique to the rest of the world. This presentation guides to a save and comprehensive procedure.

1. Scalpelless Vasectomy
Dr Dirk Grothuesmann, MScHI, MDMa
http://dg-maternalhealth.de/

3. “One sunny day does not create a summer but one
sperm passed by regardless of vasectomy might
reasoning an unintended pregnancy”
Dr med Hans-Georg Grothuesmann
Dr Hans-Georg Grothuesmann a urologist
with work experience of more than 50 years

4. Preface
“Anyone equipped with intellectual and practical abilities might fulfill
essentials to learn how to perform surgeries. Regardless surgeons must
understand both their own limitations as well as the limitations given
by the environment in place.
Essential for surgical procedures like definitive contraceptive procedures
similar to vasectomies are well trained providers with in-depth
understanding of the anthropological context where these highly
sensitive surgeries are performed.”
Dr Dirk Grothuesmann

5. Code of Ethics for Surgery Procedures
• Dedication to provide the best possible procedure based on
circumstances in place
• The surgeon must realize the vulnerability and related root causes of
the population treated
• Personal responsibility for the perioperative care should be assured
• No hubris, accept own and infrastructural limitations and select
patients accordingly
• Collect/review data on treatment outcomes
Dr Grothuesmann,
own source 2019

6. History of Scalpelless Vasectomy
• Vasectomy has long been a safe, effective, easy-to-perform method of
contraception for men
• Throughout its history, people have been trying to find ways to make
the procedure simpler
• Dr. Li Shunqiang developed the no-scalpel vasectomy technique, and
in 1986, EngenderHealth in cooperation with Dr. Li, began to
introduce the technique to the rest of the world.
NO-SCALPEL VASECTOMY An Illustrated
Guide for Surgeons Third Edition, printed
1997

7. Requirements to providing high-quality
Vasectomy
• A waiting area with a toilet (the waiting area may also serve as a
recovery area.)
• A private space for counseling
• An examination room for the preoperative assessment and follow-up
examination
• A clean room for surgery, equipped with a comfortable, clean table
for the client and a good light source
Common Sense, 2019

8. Requirements to providing high-quality
Vasectomy
• The temperature of the operating room should be at least 70 to 80
degrees F (approximately 20 to 25 degrees C)
• A warm room facilitates the following:
• Manipulation of the vas by using the three finger technique
• Fixation of the vas under the median raphe of the scrotum
• Isolation of the vas from the relaxed spermatic cord
• Reduction of operating time
• Reduction of complications
NO-SCALPEL VASECTOMY An Illustrated
Guide for Surgeons Third Edition, printed
1997

9. Instruments and Supplies I
The extra;cutaneous ringed forceps is a type
of clamp used to fix the vas deferens
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10. Instruments and Supplies II
The dissecting forceps is similar to a curved mosquito hemostat,
except that the tips are sharply pointed. It is used to puncture the
scrotal skin, to spread the tissues, to dissect the sheath, and to
deliver the vas deferens.

11. Supplies III
• Adhesive tape and gauze for positioning
the penis away from the surgical field
(optional)
• Scissors for clipping any scrotal hair that
would interfere with the procedure
• Soap and water or antiseptic agents for
the
• surgical scrub
• Alcohol rinse (recommended if plain soap
is used for the surgical scrub)
• Sterile gloves
• Nonirritating antiseptic solution for
cleaning the operative area
• Sterile drapes
• 10-cc syringe with a 11⁄2-inch, 25- or 27-
gauge needle (U.S. system)
• 1% or 2% lidocaine without epinephrinea
• Supplies for vasal occlusion according to
the surgeon’s preference (examples: a
cautery unit;
• absorbable or nonabsorbable suture
material for ligation)
• Sterile gauze
• Adhesive tape or Band-Aid for dressing
the wound
• Scrotal support for the man to wear after
the procedure (optional)

12. Anatomical Landscape for sufficient Local
Anesthesia
NO-SCALPEL VASECTOMY, An Illustrated
Guide for Surgeons Third Edition, printed
1997

13. The Three-Finger Technique: Isolating the left
Vas

14. Technique of Local Anesthesia Application
Without withdrawing the syringe, slowly
inject 2 to 5 cc (depending on concentration) of
lidocaine within the external spermatic fascial sheath

15. Grasping the vas with the ringed clamp,
extracutaneously (scrotal skin not shown for clarity)
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16. Pressing the tips of the ringed clamp onto the
scrotal skin overlying the right vas
Lowering the handles of the ringed clamp to elevate
the vas and mobilize under the superficial skin

17. Preparation of the Vas deferens I
Pressing the index finger lightly downward to tighten
the scrotal skin just ahead of the tips of the ringed
clamp and over the anesthetized area is essential for
accessibility of the vas deference
NO-SCALPEL VASECTOMY, An Illustrated Guide
for Surgeons Third Edition, printed 1997

18. Preparation of the Vas deferens II
Piercing the skin to access the vas with the medial
blade of the dissecting forceps

19. Preparation of the Vas deferens III

20. Preparation of the Vas deferens IV
NO-SCALPEL VASECTOMY, An Illustrated Guide
for Surgeons Third Edition, printed 1997

21. Preparation of the Vas deferens V

23. Preparation of the Vas deferens VI
NO-SCALPEL VASECTOMY, An Illustrated Guide
for Surgeons Third Edition, printed 1997

24. P
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25. Steps in performing vasectomy by ligation with
excision I
NO-SCALPEL VASECTOMY, An Illustrated
Guide for Surgeons Third Edition, printed
1997

26. Steps in completing vasectomy by fascial
interposition II
NO-SCALPEL VASECTOMY, An Illustrated Guide
for Surgeons Third Edition, printed 1997

27. Steps in completing vasectomy by fascial
interposition III
The completed fascial interposition, with the stump
of the prostatic end outside the fascial sheath and
the stump of the testicular end inside the fascial sheath
NO-SCALPEL VASECTOMY, An Illustrated Guide
for Surgeons Third Edition, printed 1997

28. Dressing the Wound
Wash the small wound by swabbing with an antiseptic solution. A sterile gauze dressing
can be held in place with a scrotal supporter or tape, or a Band-Aid can be used to cover the small wound.

29. Literatur and other Sources
NO-SCALPEL VASECTOMY An Illustrated Guide for Surgeons Third Edition, printed
1997, Betty Gonzales, ISBN: 9780960453665
Lastly overall Clinical Experiences
and Narratives by my beloved father
Dr Hans-Georg Grothuesmann

30. Aim of my Project
Dr. Dirk Grothuesmann Consultancy
Improving Medical Services like Maternal Health, Gynecological
Services & Others by Training Health Care Providers: Relaying on
standardized training modules I teach evidence-based procedures and
related evaluation tools to local personnel in developed and developing
countries. Completing the programs offered, skills gained enable to
serve people in need in any requested setting. My approaches are
based on a economically, socially, culturally, and environmentally
sustainable foundation.
http://dg-maternalhealth.de/index2.html

31. Realizing your Path will guide you to your desired Destination, Dirk Grothuesmann

32. http://dg-maternalhealth.de/
Dr Dirk Grothuesmann
Consultancy