No-scalpel vasectomy: the transfer of a refined surgical technique from China to other countries.

Abstract

In June 1985 a surgeon from the Association for Voluntary Surgical Contraception (AVSC) visited the Chongqing Family Planning Scientific Research Institute (CFPSRI) to learn about new vasectomy methods such as the no-scalpel technique and the nonsurgical chemical infection technique. He concluded that all vasectomists should only use the no-scalpel vasectomy technique (developed by Dr. Li Shunquiang) and if they do more surgery than this technique requires they must defend their reasoning. AVSC suggested to CFPSRI surgeons that they train cadres of family planning practitioners outside of China in the no-scalpel technique. It also promoted this transfer of technology within ongoing vasectomy services. CFPSRI and China have continuously provided training evaluations teaching materials and surgical instruments for training beyond its borders. In October 1986 Dr. Li trained midlevel surgeons in the no-scalpel technique in Thailand. By December 1987 the no-scalpel vasectomy technique used in Thailand resulted in lower complication rates and lower surgical time. A Chinese surgeon trained US surgeons in 1986-1988. They accepted the no-scalpel technique which was needed to gain acceptability by non-US surgeons. As of December 1989 some surgeons in 14 countries used the no-scalpel technique and more and more practitioners asked for training and expanded services in the no- scalpel technique. Various surgeons have attempted to modify Dr. Lis technique and reproduce his instruments but these changes did not improve the technique. In fact they tended to frustrate the surgeon prolong surgery and cause some complications. The only widely accepted modification was cautery of the vas. The key steps of the technique included 3 finger fixation; anesthesia infiltration; and grasping exposing delivering and isolating the vas. Continued success of this technique is dependent on the collaboration of its originators in China.