Step V
Excise and Cauterize the Vas
At this point, you have stripped the fascia away from the vas deferens. You will now excise a portion of the vas deferens and cauterize the remaining free ends.
1. After the vas has been completely stripped of fascia, apply a hemostat to each end of bare vas.
a. Be careful to apply the only to the first click of the instrument handle lock. You want to avoid occluding the vas lumen and causing tissue necrosis.
b. The hemostats should be applied just inferior to the two sites where you intend to cut and excise the vas.
c. You should remove at least a 1cm section of vas.
d. The ringed clamp can be removed after securing the vas with the two hemostats.
In this image: Apply hemostats to vas deferens, isolating a 1cm section to be removed.
2. Remove the section of vas between the two hemostats by cutting each end with scissors.
a. Save the excised portion to be placed in a pathology specimen bottle later.
In this image: A 1cm section of vas deferens has been removed.
3. Cauterize the two free ends of vas.
a. Insert the cautery tip into the lumen to the full extent of the tip.
b. Activate the instrument while slowly pulling it out of the vas. The goal is to achieve a gradient cauterization of the vas lumen, and avoid causing tissue necrosis.
i. This is usually achieved with the tip activated for three to five seconds while inside the vas lumen.
ii. The mucosa of the vas will blanch when the appropriate amount of cautery has been applied. This is grossly visible.
In this image: Cauterize the vas lumen. Note that cautery instrument is inserted to its full length.
c. After cauterizing the lumen, cauterize the cut surface of the vas.
i. Activate the cautery, and gently touch it to the cut surface of vas briefly.
ii. Again, be sure to avoid causing tissue necrosis.
In this image: Cauterize the free ends of the vas deferens. Be careful not to cause tissue necrosis.
d. Repeat the steps on the other free end of the vas.
4. Check for adequate hemostasis at this time, treating any bleeding vessels as needed.
At this point, you have completed the procedure on the right vas deferens, unless you choose to perform fascial interposition, described in the next section.