Step VII
Repeat Steps on Left Side
At this point, you have finished all steps on the right vas deferens. You will now repeat the steps on the left vas deferens to complete the procedure.
If not done previously, administer anesthesia as shown in Step II to the left vas at this time. Otherwise, proceed with the remaining steps.
1. Grasp the left vas deferens, using the three finger technique for the left vas deferens.
a. Reach across the abdomen and grasp the left vas deferens using your left hand.
b. Position your index finger distal, your thumb proximal, and your middle finger between them on the underside of the scrotum.
2. Isolate the left vas deferens in the ringed clamp.
a. Apply the ringed clamp to the isolated vas deferens through the previous skin puncture site.
In this image: Applying the ringed clamp to the left vas deferens, through the previous skin puncture site. Note the finger positioning in the three-finger technique.
3. Expose the vas by stripping the fascia.
4. Excise and cauterize the vas.
5. Perform fascial interposition if desired.
Note
It is desirable to attempt to bring the left vas deferens to the site of previous skin puncture, and apply the ringed clamp to the vas through the skin puncture site. This avoids having to create another skin puncture site to operate on the left vas. However, this is not always possible, and you may need to create a new skin puncture site. Remember to administer anesthesia to the skin at the new puncture site if necessary.
You have now completed all of the surgical steps of the procedure.