Preoperative Diagnosis: Elective sterilization
       Postoperative Diagnosis: Elective sterilization
       Operation: Bilateral no-scalpel vas ligation
       Attending Surgeon: Lawrence C. Jenkins, MD
       Assistant Surgeon: ***
       Anesthesia: Local 0.5% bupivicaine 5mL
       Anesthesiologist: None
       Location: Urology procedure room
       Surgical Service: Urology
       Specimens: none
       Complications: none
       Estimated blood loss: 2 mL
       Indications: Mr. Choate is a 31-year-old, who presented to the office desiring elective sterilization. The risks and benefits were discussed with the patient and informed consent was obtained. He presents today for the procedure.
       Procedure:
       The patient was brought to the procedure room and placed in supine position. His scrotum was prepped with Hibiclens and he was draped sterilely in the usual fashion. A timeout was performed.
       The median raphe and both vasa were infiltrated with local anesthetic using a high-pressure jet injector. The median raphe was punctured, spread and the right vas delivered. The vas was transected and the lumina were cauterized for a distance of a 0.5 cm with cautery in either direction. Fascial interposition was accomplished by sealing the abdominal end in the vasal sheath with a single Weck Hemoclip. The right vas was returned to the scrotum. The left vas was brought up through the same puncture wound and an identical procedure was performed. The left vas was returned to the scrotum. There was minimal bleeding. No sutures were required. The puncture wound contracted. Sterile dressings were held in place by scrotal supporter. The procedure was terminated with the patient in satisfactory condition.
       It was reiterated to the patient that he would remain fertile for sometime and should present to the lab for a post-vasectomy semen analysis to confirm sterility. The patient expressed understanding.
       Lawrence Jenkins, MD, was present in the room for the entire procedure today.