NSV June 2003

karbBaÄb;keNItCaGciéRnþy_edaysµ½R

KcitþelIburs

bgðajedayevC©> lI Twg

NSV June 2003

GVIeTAEdlehAfa NSV ?

•KWCakarkat;pþac; Vas deferens TaMgBIredayeRbIfñaMsW<k

•ehIyecaHtamEs,k Scrotum.

•karbBaÄb;kMeNItcMeBaHburstamrebobenHehAfa NSV

NSV June 2003

Rbvtþién NSV

qñaM 1985 GnuvtþenARbeTséf eday Dr.Phaitum Gijaseni

enA USA eday Dr. Marc Goldstein . qñaM 1986 Dr.Li, Dr. Goldstein

rYmCamYyGñkÉkeTsmkBI RbeTsbg;køaeds eN):al; nig RsIlgáa )anebIkvKÁbNþúH bNþal dl;RKÚeBTüCaeRcIneTotenA)agkk rYc)anbNþúHbNþal nig BRgIkCabnþeTARbeTsCaeRcIneTot

NSV cab;epIþmenARbeTscinnaqñaM 1974eday

Dr. Li Shunquiang

NSV June 2003

Bt’manTUeTAénkarbBaÄb;kMeNItcMeBaHburs• enAelIBiPBelak vaCameFüa)ayEdleBjniym

• kñúgcMeNammeFüa)ayEpnkarRKÜsar .

• man 33lanRKÜsar kñúgcMeNam191lanRKÜsar

• )anTTYlykmeFüa)ayenH .• vaCameFüa)ayEdlmansuvtßiPaBnigRbsiT§iPaBx<s;

NSV June 2003

Complications after No Scalpel VasectomyImmediate complications after NSV

Hematoma InfectionData sources# of cases

# of cases Rate # of cases Rate

8 provincesin China 1991

179.741 160 0.09% 1630 0.91%

Complications after SV

USA 1982 65155 1.95% 3.48%

complications after NSV and SV

NSV: 680 2 0.29% 1 0.15%Thailand1987 SV : 523 9 1.72% 7 1.34%

Cambodia1998-3/2003

NSV: 726 4 0.55%

NSV June 2003

karerobcM nig BinitüGtifiCnmuneBlvHkat;•RbvtþievC¢saRsþrbs;GtifiCn •cMnYnkUnEdlenArs;•Gayurbs;kUneBAeKbg¥s;•RbtikmµfñaM CaBiessCamYyfñaMs<wknigfñaMbM)at;karQWcab;

• Binitünigkt;RtasMNuMÉksarevC¢saRsþrbs;GtifiCn

NSV June 2003

karBinitüGtifiCn Physical examination

• sßanPaBTUeTA³ PaBesøksøaMg sm<aFQam CIBcr>>>

• BinitüsrIragÁbnþrBUC³– Scrotum: rbYs CMgWesIrEs,k

sñamsMlakFøab;manvHkat;BImun

mandMusac;bJuTwk nigPaBxusFmµtaepSg²eTot – ligÁ ³ mandMe)A rbYs bJu hUrTwkrég-xÞúH>>>– BgsVas ³ sPaBrbs;va mandMusac; bJuTwk>>>– Spermatic cord: sPaBrbs;va mandMusac;sÞabb:H>>>– Inguinal region: :rbYs CMgWesIrEs,k

sñamsMlakHkat;BImun

NSV June 2003

Indications én NSV

• eqøIytbeTAnwgeKalneya)ayrbs;RksYgsuxaPi)al³– Gayurbs;Priya– cMnYnkUnenArs; nig Gayurbs;kUneBAeK– bBaðasuxPaBeBlmanépÞeBaHbJueBlsMral

• GtifiCnyl;RBmedaysµ½Rkcitþ edaymankic©RBmeRBog

• Kµanlkç½NevC¢saRsþNaEdlhamXat;karvHkat;)anenaHeT

• EteyIgRtÚvkMNt;fakarvHkat;eFVI)anedayrebobNa

• enAeBlNa ehIyenAkEnøgNa WHO, 1995

NSV June 2003

Precautions én NSV

• dMe)AkøayenA Scrotum• man

infectionRsÜcRsavenARbdab;bnþrBUC ³ sVay RbemH>>>

• man infectionRsYcRsavenARbB½n§NamYy

• manCMgWebHdUg bJuvibtþiQamkk• manCMgWTwkenamEpÐm• manbBaðaepSg²eTot³ Large varicocoele,

Inguinal hernia, Filariasis, Previous scrotal surgery, Intra scrotal mass, Scar tissue, AIDS related disease

NSV June 2003

bBaðaEdlRtÚvBicarNa

• GtifiCnEdlenAcg;)ankUneTot• GtifiCnEdlmanKMnitfa meFüa)ayenHGactP¢ab;vij)an

• GtifiCnEdlminRBmcuHhtßelxaelIcic©RBmeRBog

• TaMgBIrnak; bþI-RbBn§• GtifiCnEdlmankarbgçwtbgçM bJuCMrujBIGñkdéT

• GtifiCnEdlmancitþrn§t;• GtifiCnEdlmanbBaÐðapøÚvcitþ

NSV June 2003

viFIsaRsþcak;fñaM;s<wk nig viFIsaRsþvHkat;

NSV June 2003

NSV Instruments

NSV June 2003

Positioning

NSV June 2003

bec©keTsRmaméd3

NSV June 2003

bec©keTsRmamé

d3

NSV June 2003

BIviFIsaRsþcak;fñaMs<wkkñúg NSV

NSV June 2003

BIviFIsaRsþcak;fñaMs<wkkñúg NSV

NSV June 2003

BIviFIsaRsþcak;fñaMs<wkkñúg NSV

NSV June 2003

Direction inguinal canal

Male anatomy and loco-regional anesthesia

NSV June 2003

BIviFIsaRsþcak;fñaMs<wkkñúg NSV

NSV June 2003

NSV June 2003

BIviFIsaRsþkat;cg Vas kñúg NSV

NSV June 2003

90 degrees

NSV June 2003

Verification of the presence of the vas

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Ligation

Dr Ly Tung’s hint: pull a double threat and cut it

NSV June 2003

Ligation and cut

NSV June 2003

Ligation and cut

Testicular end Prostatic end

NSV June 2003

Fascial interposition

NSV June 2003

Fascial interposition

NSV June 2003

Fascial interposition

NSV June 2003

Fascial interposition

NSV June 2003

Fascial interposition

NSV June 2003

Fascial Interposition

NSV June 2003

Fascial interposition

NSV June 2003

NSV June 2003

kartamdanGtifiCneRkaykarvHkat;• BinitüemIleLIgvij sMNuMÉksarevC¢saRsþrbs;GtifiCn

• eFVIy:agNa[GtifiCnmanpasuxPaB• tamdan Vital Signs ehIykt;RtaTuk• Binitü sßanPaBTUeTArbs;GtifiCn³ PaBesøksøaMg karQWcab;>>>

• BinitüemIl Scrotum manehIm bJuecjQam

• BinitüemIlkEnøgvH s¶Üt bJu esIm-Qam

NSV June 2003

karpþl;dMbUnµaneRkaykarvHkat; ¬1¦•etIRtÚvEfTaMy:agdUemþc?- rkSaTukbg;s¥itEdlbitelImuxrbYseGay)an3éf¶- kñúgry³eBlenHGñkGacsMGatxøÜnedayCUtxøÜnnwgkEnSg

esIm b:uEnþRtUvrkSabg;s¥itEdlbitelImuxrbYseGays¶Üt- GñkKYreCosvagkargarF¶n;² kñúgry³eBl7éf¶- p¥akkarrYmr½kSry³eBl7éf¶- ebIRKUeBTüpþl;fañMCUneTAGñk sUmGñkeRbIfañMenaH eGay)an RtwmRtUvtamevC¢bBa¢a

NSV June 2003

karpþl;dMbUnµaneRkaykarvHkat; ¬2¦ etIGVInwgekItman?- mankarQWcab;tictYcenAkEnøgvHkat; karRbúgRby½tñ ³ - ehImehIymankarQWcab;xøaMgenAelIBgsVas

- hUrxÞúH rW QamtammuxrbYs cMNucKYrcgcaM ³- GacbgárkMeNItkñúgryHeBl3ExeRkayvHkat;

- kñúgryHeBl3ExenH RtÚvrYmePTedayeRbIeRsam bJu eRbImeFüe)ayBnüarkMeNItepSgeTot

NSV June 2003

karpþl;dMbUnµaneRkaykarvHkat; ¬3¦ kartamdan ³

- RtLb;mkvij 3éf¶eRkayvH edIm,IBinitütamdan- RtLb;mkvijebImanbBaða bJusMNYr-cMgl;

NSV June 2003

dMeNIrkarén NSV cak;fñaMs<wkenAnwgkEnøgcab; Vas CamYynwgEs,k[esþIgbMputecaHEs,knig Vas edayruj)uaMgeTAmux ” Walking ”

qÁwH Vas ecjEjk Fascia edayEpømçagén)uaMgecaH sk)uaMgcUl rYcebIkha )auMgtamTisedA BIelIeTAeRkam

NSV June 2003

dMeNIrkarén NSV sþg;daénkareFVI NSV

- RtÚveFVI Fascial interposition

- Lidocaine 2% Kµan Adrenaline 2,5ml sMrab; Vas nimYy²

- m¢úlelx 25- cgeday Silk 2.0 - manRbsiT§iPaB ³ 3Ex , 12s)þah_ , 90éf¶ - RtÚveRbIeRsamligÁ

NSV June 2003

Or do you prefer this method??