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Vasectomy Procedure Note
Mar 17, 2019
•
Mark Morgan
categories:
Procedure Note
VASECTOMY PROCEDURE NOTE
PROCEDURE: Elective Bilateral Vasectomy -CPT 55250
PRE-OP DIAGNOSIS:
FINDINGS:
none
speech input
POST-OP DIAGNOSIS:
ANESTHESIA:
Lidocaine 1% without epinephrine
Lidocaine 1% WITH epinephrine
Lidocaine 2% without epinephrine
Lidocaine 2% WITH epinephrine
Marcaine 0.5%
Sodium BiCarb buffering solution
. Total amount used:
ml.
Supervising Physician:
Dr.
INDICATIONS/COUNSELING:
-Patient desires elective sterilization.
-Confirmed that Patient was counseled regarding the risks, alternatives, and benefits of male sterilization by vasectomy.
-Confirmed that patient was informed of the risks of the procedure, including but not limited to failure of the procedure to produce sterility, the risks of bleeding, infection, chronic testicular pain, and injury to scrotal contents.
-Confirmed that all questions were answered in the pre-vasectomy counseling visit. No guarantees were given or implied.
-Verified that the consent form was signed prior to patient taking preprocedural medication(s).
-A time out was performed prior to the procedure and documented in a hardcopy form to be scanned into patient's record to include ensuring:
only select what's applicable
-Patient was identified using full name and DOB.
-Patient was evaluated and medical record reviewed including history and lab/imaging findings if applicable.
-Procedure and site/side matches the consent form.
-Patient was involved in the site/side marking.
-For final timeout, physician paused or verbally confirmed with procedure team of:
-correct patient, correct procedure, and correct site/side.
-The patient has been positioned correctly for the procedure.
-All necessary equipment are available.
-Instrument sterility verified.
PHYSICAL EXAM:
Inspection/Palpation of the genitalia:
unremarkable
see below
choose one
-no significant abnormalities or contraindications to performing the vasectomy in the outpatient clinic
-both testes normal without tenderness, masses, hydroceles, varicoceles, erythema or swelling.
-penile shaft normal, meatus normal without discharge
-anatomic landmarks were confirmed
speech input
describe abnormalities/anomalies
PROCEDURE
-The patient was laid supine on the procedure table.
-He was prepped and draped in the usual fashion using
Chlorhexidine
Betadine/Iodine
and allowing proper dry time per manufacturer and infection control recommendations.
-After identifying the vasa bilaterally, the left vas was grasped using the three-finger technique.
-Using a 27g needle, a 1-2 cm wheal was made at the
left scrotum
right scrotum
midline scrotal raphe
1 cm distal to the base of the penis with anesthetic agent to provide local skin anesthesia.
-The needle was then advanced through the wheal and adjacent to the
Left
Right
Vas Deferens.
-After gentle aspiration, anesthetic agent was injected into the
proximal perivas tissue
external spermatic fascia
to achieve regional vasal block.
-The
VasSide
Vas Deferens was maneuvered to the desired incision site, and
no-scalpel technique with fine cured hemostat
fine-tip Bovie electrocautery
#15 blade scalpel
#11 blade scalpel
was used to make a 1-2 cm incision.
-The soft tissue was then bluntly dissected with fine cured hemostats.
-The
VasSide
Vas Deferens was grasped and elevated through the incision and exposed using vas fixing forceps. Perivas tissue was bluntly dissected away using
fine cured hemostats
fine-tip bovie electrocautery
.
-Once it was decided that sufficient perivas tissue had been dissected away and risk of superimposed vascular tissue over the vas deferens was low, a 1cm section of vas deferens was isolated using vas fixing forceps to grasp distal and proximal ends.
-
Hemostats
Alice clamps
were used to secure testicular and prostatic ends of vas deferens prior to transection.
-The 1cm segment of vas deferens was transected/excised using
#15 blade scalpel
#11 blade scalpel
and this 1cm section was sent for pathologic examination/review.
-
Electro
Thermal
cautery was applied to
1cm
0.5cm
length of the lumen of
both prostatic & testicular ends
the prostatic end
of the Vas Deferens until blanching occurred.
-Facial interposition achieved with figure of eight stitch
only check if applicable
using
5-0
4-0
vicryl suture material.
-The area of remaining Vas Deferens and perivas tissue exposed through the incision was inspected thoroughly.
-
Good hemostasis was noted
Gentle electrocautery applied to achieve good hemostasis
Suturing was required to achieve hemostasis
before the remaining Vas Deferens was reduced back into the scrotum.
-
5-0
4-0
vicryl suturing material used.
-These procedural steps described were repeated on the
Right
Left
Vas Deferens
using the previously created midline raphae incision
.
-
Estimated blood loss was less than 2 ml.
Estimated blood loss was
ml and
speech input
hemostatic actions taken and referral arrangements as applicable
-In the interim, patient was given post-op instructions to include:
physical limitations and work restrictions
using ice packs 20min on/off
use of scrotal support underwear (spandex/jock-strap)
avoiding contact with pets or kids for first 48-72hrs that might put patient at risk of accidental trauma and hematoma formation
picking up kit/instructions for semenanalysis from the lab
returning with semen sample to lab after 25 ejaculations AND after 13 weeks have elapsed
-Patient was given return precautions to include:
worsening pain more than 24hrs after the procedure
rapid increase in the amount of swelling of scrotum over the course of a few hours
white pus draining from wound(s)
development of fever
.
-Patient left in stable condition.
-For closure, scrotal fascia/skin was
allowed to close by secondary intention
closed with
4-0
5-0
Prolene
Nylon
Silk
Ethibond
suture material
.
-Skin was dressed with sterile gauze.
DISPOSITION
-The patient tolerated the procedure well. No immediate complications noted.
-Patient was reminded of post-procedural instructions including:
physical limitations and work restrictions
using ice packs 20min on/off
use of scrotal support underwear (spandex/jock-strap)
avoiding contact with pets or kids for first 48-72hrs that might put patient at risk of accidental trauma and hematoma formation
picking up kit/instructions for semenanalysis from the lab
returning with semen sample to lab after 25 ejaculations AND after 13 weeks have elapsed
-Gave patient return precautions to include:
worsening pain more than 24hrs after the procedure
rapid increase in the amount of swelling of scrotum over the course of a few hours
white pus draining from wound(s)
development of fever
.
-Patient left in stable condition.
-Followup plan:
speech input
.
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