Best Vasectomy Procedure in Charlotte: No-Scalpel & Low Failure
Charlotte Vasectomy
Vasectomy is a simple office based surgical procedure that permanently prevents pregnancy. The best vasectomy procedure is the procedure that provides the lowest surgical risks and the lowest chance of failure.
The physicians of His Choice provide the best vasectomy procedure to patients. His Choice doctors only provide:
- minimally invasive, no scalpel vasectomy
- a technique using coagulation and fascial interposition
- open ended vasectomy
Best vasectomy procedure: Two steps
To understand why a His Choice is the best vasectomy you need to understand the two key elements of our minimally invasive vasectomy:
- how we get through the scrotal skin
- how we divide and block the vas deferens tubes
How the skin is opened during vasectomy has a direct relationship on the after vasectomy risks of pain, bleeding, and infection.
How the vas deferens tubes are divided directly influences the risk of occlusive vasectomy failure (persistent sperm and the possibility of pregnancy).
Step 1. A minimally invasive approach
We use a no needle vasectomy technique to administer the local anesthetic. The local anesthetic is pushed through the skin with a puff of air using a device specifically designed for vasectomy.
Our doctors use a minimally invasive, no scalpel approach to get through the scrotal skin.
Minimally invasive means a single, small skin opening is created in the middle of the scrotum.
No scalpel means we spread a small opening in the skin. This allows the natural elasticity of the skin to slowly squeeze the opening closed within 24 hours of the vasectomy. Sutures are not required.
The American Urological Association strongly recommended the minimally invasive no scalpel approach in their 2026 position statement:
Surgeons should isolate and expose the vas deferens for vasectomy using a minimally invasive approach such as the no-scalpel vasectomy (NSV) technique. (Moderate Recommendation; Evidence Level: Grade A)
The technique used to get through the scrotal skin (cut vs spread) directly influences the risk of the vasectomy procedure.
Scalpel vasectomy creates larger scrotal incisions that require sutures to close. Larger scrotal incisions cause more pain, bleeding, and infection than no scalpel skin openings.
Minimally invasive, no scalpel vasectomy results in less after vasectomy risks of pain, bleeding, and infection.
Step 2. Vas division, minimizing vasectomy failure
There are many ways to divide the vas deferens during a vasectomy procedure.
How a doctor divides the vas deferens tubes to cause permanent blockage directly influences the chance of vasectomy failure.
The historical standard of dividing the vas deferens involves tying off a small section of each vas deferens and removing that section. This is called ligation (tying) and resection (removing by cutting).
Most doctors, especially those who perform scalpel vasectomy, cause tubal blockage by tying and removing small segments of each vas deferens.
Unfortunately, this older technique is associated with higher rates of occlusive failure after vasectomy.
Occlusive failure is technically defined as persistent live sperm present in the semen six months of more after the vasectomy.
Vasectomy methods that use ligation and resection can have occlusive failure rates of up to 10%. Why is ligation and resection have such a higher failure rate?
Sperm is continually produced after vasectomy. Sperm can leak from the lower ends before each end has had time to fully heal closed. Sperm leaking from the lower end can push through the healing tissue and create small channels that allow them to travel to the upper end of the cut vas deferens.
This process is called recanalization. These channels allow healthy sperm to by-pass the blocked section.
Recanalization is more likely to result in a reconnection after ligation and resection vasectomy because the upper and lower cut end of the vas deferens tubes are still in perfect alignment.
The American Urological Association recommended against using simple ligation and resection :
Surgeons should not perform vas occlusion using only ligation and excision of a short vas segment (Strong Recommendation; Evidence Level: Grade A)
Almost everyone seems to knows a ‘guy’ who got his partner pregnant 10 years after having a vasectomy. This is usually because that ‘guys’ doctor used a vasectomy method that involved simple ligation and resection.
Best vasectomy procedure: A 3 step process
The physicians of His Choice Health perform one of the most effective methods of vasectomy. Our method can provide a low risk of vasectomy occlusive vasectomy failure.
Our vasectomy procedure begins with a minimally invasive no scalpel approach to allow access to the vas deferens tubes. Compared to scalpel vasectomy our minimally invasive approach provides the lowest risks of pain, bleeding, and infection.
The vas deferens are divided in a procedure which involves three key steps:
- Division with coagulation
- Intra-luminal mucosal coagulation
- Fascial interposition
Division with coagulation. The vas deferens on each side are divided with cautery (heat energy).
Intraluminal mucosal coagulation. This involves using a limited amount of heat energy inside the vas deferens tube (the mucosal layer) of the upper end for a length of approximately 1/2 inch. This technique accelerates healing closure of the upper end. Not only does the upper end heal closed faster but it also heals closed along a longer 1/2 inch section.
Fascial interposition. This involves slightly separating the lower end out of alignment with the upper end. To accomplish this, one of two small titanium clips are placed between the two divided ends. This keeps the divided ends apart long enough for them to heal closed during the first several weeks after the vasectomy procedure.
The clips are smaller than a grain of rice and the clips are placed parallel to the vas deferens tubes. The clips do not have to be removed are are unnoticeable after the vasectomy.
The intraluminal mucosal cautery accelerates healing closure of the vas deferens tubes. Fascial interposition provides a critical second back up method to help ensure occlusive vasectomy failure.
The chance of occlusive failure after a vasectomy involving division, coagulation with intraluminal coagulation, and fascial interposition is less than 0.5%
In their 2026 vasectomy position statement the American Urological Association recommended vasectomy be performed by mucosal cautery and fascial interposition to provide the lowest chance of vasectomy occlusive failure.
Surgeons should perform vasectomy with an occlusive technique that combines mucosal cautery (MC) and fascial interposition (FI). (Strong Recommendation; Evidence Level: Grade B)
Open ended vasectomy: Just for good measure
In addition to the above steps, the physicians of His Choice Health also allow the lower end of the divided vas deferens to remain open after the vasectomy procedure. This is commonly referred to as an ‘open ended vasectomy technique’.
The technique of ligation and resection results in the lower end being instantaneously closed during the vasectomy procedure. Sperm are continually produced in the lower end after vasectomy. As a result, pressure in the lower end could increase more rapidly after a closed end vasectomy technique. This may result in more pain and discomfort during the vasectomy recovery period.
With an open ended technique the lower end is allowed to remain open. This allows sperm to slowly leak out of the lower end during vasectomy healing. This can result in less pressure inside the lower vas deferens and epididymis and less painful symptoms during vasectomy healing.
The lower end will slowly, but eventually, heal closed. The key word is slowly. This should provide more time for the testicle, epididymis and the lower vas deferens to adapt to the vasectomy procedure.
Some patients are worried that leaving the lower end open may increase the chance of vasectomy failure. This does not appear to be the case. The additional techniques of intraluminal cautery and fascial interposition greatly decrease the chance of vasectomy failure.
The American Urological Association does not provide a statement on the open ended vasectomy technique. The current literature suggests open ended vasectomy could provide some benefit but does not appear to be harmful or increase the risks of vasectomy .
Separating the Facts & Myths
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