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Isolate Vas in Ringed Clamp
At this point, you have anesthetized the scrotal skin and vas deferens. You will now isolate the right vas deferens in the ringed clamp, in preparation for dissecting through skin and fascia to expose the vas.
1. Grasp the right vas in your left hand, using the three-finger technique.
a. Recall the proper hand positioning, using your thumb, index finger, and middle finger.
b. Refer to the anesthesia section to review the proper hand and finger positioning if needed.
2. Pick up the ringed clamp in your right hand, holding it palm up.
3. Apply the ringed clamp to the vas, encircling overlying skin in the clamp as well.
a. Make sure to apply the clamp over the previously anesthetized skin at the median raphe.
i. It is wise to test the skin for adequate anesthesia before fully applying the clamp.
b. Press downward with the ringed forceps while at the same time applying upward pressure on the vas with your middle finger.
In this image: Applying ringed clamp to the right vas deferens. Note positioning of fingers.
4. Check that you have isolated the vas by palpating immediately proximal and distal to the tip of the instrument, feeling for the vas deferens.
In this image: Palpating vas to ensure it is isolated in the ringed clamp.
5. Transfer the ringed clamp to your left hand.
6. Create tension in the skin, where the skin puncture will occur in the next step.
a. Gently raise the tip of the clamp while lowering the handle, to elevate the vas.
b. Place your index finger just proximal to the tip of the clamp, creating some tension in the skin between the finger and the tip of the clamp.
In this image: Create skin tension. Tip of ringed clamp is elevated, index finger is applying tension to the skin just distal to the ringed clamp.
You have now isolated the vas in the ringed clamp. You are ready to create the skin puncture and dissect through the fascia to expose the bare vas deferens.
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