A comparative study of the no scalpel and standard incision approaches to vasectomy in 5 countries. The Male Sterilization Investigator Team. Randomized clinical trial of diathermy versus scalpel incision in elective midline laparotomy.
We compare the safety, ease of use and effectiveness of the no scalpel and standard incision approaches to vasectomy.
                A multicenter, randomized, partially masked controlled trial was conducted at 8 sites in Brazil, Guatemala, Indonesia, Sri Lanka and Thailand. Semen samples were collected 10 weeks postoperatively and tested to ascertain sterility using verification of no living spermatozoa.
                The study included 1,429 men seeking vasectomy. The efficacy of the 2 approaches was virtually identical. In the no scalpel group operating time was significantly shorter, and complications and pain were less frequent than in the standard incision group. The no scalpel group resumed intercourse sooner, probably as a result of less pain following the procedure.
                The no scalpel approach is an important advance in the surgical approach to vasectomy, and offers fewer side effects and greater comfort compared to the standard incision technique, without compromising efficacy. Electrocautery is used increasingly for tissue dissection, although fears of excessive scarring and poor wound healing have curtailed its widespread use for skin incision. This study compared electrosurgical incision with traditional scalpel incision.
                One hundred patients requiring elective midline laparotomy were randomized prospectively to either scalpel or diathermy incision. Parameters measured included incision time, wound size, wound blood loss, total intraoperative blood loss and postoperative wound pain. All wound complications were recorded.
                The two groups did not differ significantly in relation to patient or wound characteristics. Laparotomy incisions using diathermy were significantly quicker than scalpel incisions (mean(s. e.m.) 6.1(0.4) versus 7.5(0.5) s/cm2; P < 0.04). There was significantly less blood loss in the diathermy group compared with the scalpel group (0.8(0.1) versus 1.7(0.3) ml/cm2; P = 0.002). Postoperative pain scores were significantly lower in the diathermy group for the first 48 h after operation (P < 0.05). Morphine requirements were also significantly lower over the first 5 postoperative days in the diathermy incision group (P < 0.04). There was no difference between groups in wound complications before discharge and at the 1-month follow-up.
                Electrosurgical midline incision in elective surgery has significant advantages over scalpel use on the basis of incision time, blood loss, early postoperative pain and analgesia requirements.
The no-scalpel approach to the vas resulted in less bleeding, hematoma, infection, and pain as well as a shorter operation time than the traditional incision technique. No difference in effectiveness was found between the two approaches.