Fascial Interposition
At this point, you have excised a portion of the vas and cauterized the remaining free ends. You will now perform fascial interposition, if desired, to theoretically further decrease the risk of failure.
Note
Fascial interposition is an optional step in no-scalpel vasectomy. It has been reported that fascial interposition decreases failure rates, but the data is inconclusive.
Fascial interposition involves sewing fascial tissue over the free prostatic end of vas. The fascial tissue used in the oversewing is that which was previously stripped from the vas.
1. With a hemostat still in place on the prostatic end of cauterized vas deferens, identify surrounding fascial tissue.
2. Grasp the fasical tissue, using a hemostat or toothed pickup, and encircle the free prostatic vas deferens within it, creating a "pocket" of fascia.
3. When you have secured fascial tissue around the free prostatic vas, remove the hemostat from the vas.
a. Allow the vas to "fall" freely within the pocket of fascia.
4. Sew the fascia closed.
a. Use small-caliber, absorbable suture, such as 4-0 chromic.
b. Usually, two or three simple interrupted sutures or a purse-string closure is sufficient.
At this point, you have completed the procedure on the right vas deferens.