Vasectomy

SURGEON: Dr. ____

ASSISTANT: Dr. ____

PREOPERATIVE DIAGNOSIS: Elective sterilization

POSTOPERATIVE DIAGNOSIS: Elective sterilization

PROCEDURE: Bilateral vasectomies

FINDINGS: 1. Successful bilateral vasectomies

ANESTHESIA: Local with sedation

INTRAVENOUS FLUIDS: IV crystalloid

ESTIMATED BLOOD LOSS: 2ml

TUBES AND DRAINS: None

SPECIMENS: left and right vas deferens

COMPLICATIONS: None

INDICATIONS FOR PROCEDURE:  The patient is a _ yr old who desires of family planning . Dr. discussed the options with the patient who has agreed to have bilateral vasectomies. Prior to the procedure today, the patient's history and physical was reviewed. Informed consent was obtained and all questions were satisfactorily answered. The risks and benefits of the procedure including pain, damage to surrounding organs including the testicles and surrounding organs, infection, bleeding and complications from anesthesia and other complications were discussed, the patient acknowledged and communicated understanding of these risks and wished to proceed with the procedure. The patient understands he will not be sterile immediately following the procedure.

 

OPERATIVE DETAIL:  The patient was transferred to the operating room suite and placed on continuous pulse oximetry and cardiac monitoring by anesthesia.  IV antibiotics including 2g ancef were administered. IV sedation was administered.  The patient was in the supine and prepped and draped in the normal sterile fashion.  Time out was performed confirming patient, procedure, side, all in the room agreed.  SCDs were on and functioning We began the case by palpating the left vas deferens and bringing this up to the undersurface of the skin. We then injected ml of 1% lidocaine on the skin overlying the vas on this side. We then used a #10 blade to incise down through skin and the dartos layer and subcutaneous skin layers. We then used sharp hemostats to open up this incision wider and then used a vas clamp to grasp the vas deferens and bring it out of the incision. The tissue surrounding the vas and the basal adventitia was dissected off using the scalpel and sharp hemostat to expose the vas deferens. We then clamped the vas to keep it from falling into the incision and clipped the vas in two locations and excised the inner piece and sent it for pathology. We then fulgurate the inner lumen of the vas deferens. The vas deferens and tissue in the incision were carefully evaluated for hemostasis which was obtained with electrocautery. The vas deferens was dropped into the incision and brought back out to ensure hemostasis. Excellent hemostasis was obtained on this side. We then directed our attention to the right hemiscrotum and palpated the right vas deferens and bringing this up to the undersurface of the skin. We then injected ml of 1% lidocaine on the skin overlying the vas on this side. We then used a #10 blade to incise down through skin and the dartos layer and subcutaneous skin layers. We then used sharp hemostats to open up this incision wider and then used a vas clamp to grasp the vas deferens and bring it out of the incision. The tissue surrounding the vas and the basal adventitia was dissected off using the scalpel and sharp hemostat to expose the vas deferens. We then clamped the vas to keep it from falling into the incision and clipped the vas in two locations and excised the inner piece and sent it for pathology. We then fulgurate the inner lumen of the vas deferens. The vas deferens and tissue in the incision were carefully evaluated for hemostasis which was obtained with electrocautery. The vas deferens was dropped into the incision and brought back out to ensure hemostasis. Excellent hemostasis was obtained on this side. We then closed incisions using 4-0 chromic in interrupted fashion taking adequately depth sutures for hemostatic purposes.. We then placed interrupted fashion bacitracin on the incisions, fluffs and patient had scrotal support placed and he was awakened from anesthesia and transferred to the PACU in stable condition. Patient tolerated the procedure well. Please note that Dr. was present throughout the entire length of the procedure.

 

PLAN:  The patient will be discharged after meeting anesthesia criteria.  Patient was given given prescriptions for norco and miralax. . The patient knows he will follow up in the future for semen analysis prior to being sterile which the patient is aware, he is not sterile unless cleared after 2 semen analysis when cleared by Dr. and will follow up for post op check in 1-2 weeks.