As the surgeon who brought the no-scalpel vasectomy to the Western World in 1985, Dr. Marc Goldstein, The Hardy Distinguished Professor of Reproductive Medicine and Urology at Weill Cornell Medical College and Surgeon-in-Chief, Male Reproductive Medicine and Surgery at New York Presbyterian Weill Cornell Medical Center, tried this technique on a dozen reversals about 15 years ago. Used on men with short intervals since vasectomy, and minimal or no gaps, he found good early patency rates but almost a 50% late (18 months) shut down rate. This rate is far higher than previously reported (in 1995) late shut down rate of 15% which has been decreased to 6% with more extensive freeing up of the vas and cutting further back to good blood supply and healthy tissue. The morbidity of the 2.5 cm bilateral high scrotal incision is minimal and patients return to desk work as quickly as after a NSV.

However, Dr. Goldstein does have some reservations, for two primary reasons:
1. The technique does not allow vaso-epididymostomy, which is required on one side in at least 1/3 of reversals, especially more than 10 years out from vasectomy. He notes that if it is determined that a VE is necessary, a separate scrotal incision is necessary.
2. The technique does not allow extensive freeing up of the vas in the case of large vasal gaps or extensive fibrosis of the vas.


As Dr. Goldstein explains, the principles of an accurate anastomosis are:
1. tension free anastomosis.
2. good blood supply
3. accurate mucosa to mucosa approximation. The no-scalpel technique does not optimize the first two. (Goldstein, M, and Tanrikut, C., Microsurgical management of male infertility. Nature Clinical Practice Urology 3:381-391, 2006).


In summary, Dr. Goldstein does not recommend this technique, suggesting that there is "much more downside than upside".