No-Needle No-Scalpel Vasectomy (NNNSV) Training for Physicians

Getting Started | Recruiting Patients | Fees | Instruments | Loupes | Free Info

Having dedicated my practice to vasectomy and office-based vasectomy reversal since 1999, not to mention having had a pretty brisk vasectomy and reversal practice when I was still seeing new general urology patients prior to 1999, I have gotten pretty good at those procedures. What surprises me is the fact that I feel more comfortable with vasectomy this year after 45,000 procedures than I did six years ago after 35,000 procedures. While no-one can understate the value of practice (after reading the book and watching the videos), there may also be value in hands-on training with someone who has already had a lot of practice, subtle things like patient relaxation and the nuances of hand and finger position.

Because over 40% of American pregnancies are unintended, and because many of these occur within couples who are perfectly content with the number of children that they already have, and because other forms of contraception fail so frequently, and because vasectomy fails so infrequently, and because I hate to see the environment degraded by suburban sprawl and habitat loss due to never-ending population growth, I am an enthusiastic promoter of vasectomy. I would like to see the reputation of vasectomy (as an almost painless and simple procedure) soar to the extent that more men who feel they have enough children get vasectomies before they cause unintended pregnancies rather than after. By sharing what I have learned with present and future vasectomists, so that patients rave about the simplicity of their vasectomies, perhaps that goal will be achieved.

And since acquiring an associate in July 2016, I have more time for training and international work.

So I offer NNNSV training (for some we will call it "refinement") at my Tampa office. Here is how:

1. When you, the practitioner/trainee, decide that you want training, you contact me by telephone (813-536-1430) or e-mail (try our Contact Us page, but call if you do not receive a response within a day). Then, by phone or e-mail, we decide on a date that works well for both of us. In the Tampa/Lutz office, vasectomies are routinely performed by my associate and me on Tuesdays, Thursdays, and Fridays (see Our Schedule). On Monday mornings I still see a few long-established general urology patients, then do a series of reversal consults in the afternoon. Wednesday is usually an administrative day, but when we have a trainee, we can shuffle administration into another time block so that trainees can get 2-3 consecutive days of training. We used to schedule all training cases early in the week, but now find that we are more likely to attract patient-volunteers with appointments later in the week. So now we are scheduling training Wed-Fri or Thu-Fri, depending on the number of cases desired by the trainee. Typically, on the first day of training, the trainee observes 4 vasectomies during the first hour, then we alternate between observation and hands-on training cases. On the second day, we alternate cases. Most trainees have found value in training on consecutive days, rather than trying to get it all in on one day, to allow the first day's experience to settle in overnight. This provides for a total of 12-16 observation cases and 8-12 hands-on training cases over 2-3 days. On the morning of the second day, I usually schedule a reversal because most vasectomists gain perspective by participating in a reversal during their vasectomy training. Dates marked TD in Our Schedule are dates already commited to trainees who have paid deposits of $1000 to secure them.

2. After you secure your dates by paying a deposit (see #3 below), we recruit patients for the training days. A link on the homepage of this website conveys an offer for vasectomies at $200 off the usual fee on those days (we can increase the discount as the day approaches if needed to recruit enough patients). Clicking that link brings up the page that explains the arrangement ... something like this:

Note: On Thursday, June XX, 2021 at his Tampa office, Dr. Stein will host a training day for Dr. John Doe, a [Specialty Resident] [Urologist] [Family Doctor] in Hometown, State or Country. Dr. Doe would like to learn to perform vasectomies in order to be able to provide the service for [his own patients] [a local Planned Parenthood clinic which serves men of all income levels] [his county health department] in the Hometown area. Observation is helpful, but there is no substitute for "hands-on" training. Vasectomies performed while Dr. Stein trains another physician usually will take about 40 minutes, whereas Dr. Stein's routine vasectomy procedure takes 10-15 minutes. So we are looking for men with patience and a desire to save $200.00 (33%) off the usual vasectomy fee. Since Drs. Stein and Doe will work together on each patient, there should be no increased risk of either complications or pain, but there will be more manipulation of the vas tubes as Dr. Stein shows Dr. Doe how to position and access the vas on each side. Patients will hear Dr. Stein explain the procedure. Some hardy men will even be interested enough to lift up on their elbows and observe, which is always fine with Dr. Stein. Because of the reduced rate and the need for men who are not likely to postpone to a later date at the last minute (Dr. Doe cannot learn on men who don't show up), we ask for the full (discounted) payment at the time June XX  training cases are scheduled. Thank you.

The recruited patients know beforehand that they are training subjects. They are very cooperative and patient.

3. Fees: There is never a charge for observing. You may come to my office anytime and I will teach you everything I know about promoting and providing vasectomy services. But hands-on training is different, because most patients do not want to be training cases unless there is something in it for them, like a reduced fee. A reduction of $100 was not appealing enough to fill our training spots; $200 works better, but it can still be challenging to find enough volunteer patients.

So here is how it works:  The trainee is charged $350 per hands-on training case payable by check or Visa/MasterCard. $200 of that covers the discount offered to the patient. A deposit of $1000 is required to secure the dates. Up to 8 weeks prior to the training date, it is refundable less the credit card/PayPal fee if a credit card is used. It is NOT refundable after a date 8 weeks before the training day, as training opportunites are in some demand and other trainees cannot arrange travel on short notice. The balance is due at least 8 weeks before the training day (so that we have enough time to recruit patients). The dates marked TD (for Training Day) in Our Schedule are dates committed to trainees who have already paid deposits. It takes 2-4 weeks between trainees to recruit 8-12 men willing to be training cases for the discount.

4. If you are coming from OUTSIDE the USA, and if you want to avoid shipping and customs fees, you may order a MadaJet and at least one set (preferrably 3 sets) of instruments shipped to my office before the training day. The VasectomyStore.com offers a number of Packs. For three sets of instruments and use of metal clips for fascial interposition or vasal occlusion, choose  Pack 2 with 3 Aesculap clip appliers, and Vitalitec clips. I actually own so many Weck Hemoclip appliers that I need compatible Weck Hemoclips; and I prefer the Weck Hemoclips because they are supplied in 10-clip cassettes that will not melt in the autoclave like Vitalitec clip cassettes do. The VasectomyStore stocks the Weck clip appliers and clips.  VasectomyStore's rationale for promoting the 6-clip cassettes is that most vasectomists perform few vasectomies and prefer not to autoclave partially used cassettes. Cassettes of 6 provide a few extra clips and less waste than 10-clip cassettes if unused clips are not re-sterilized. If you don't mind discarding unused clips, then the Aesculap/Vitalitec system if fine. If you want only one set of NSV instruments and one clip applier, then Pack 1 is acceptable. But with only one set of instruments, you will not be able to perform a series of vasectomies without autoclave time between each case, and if you drop an instrument, you will have trouble finishing the case without a replacement.

If you are from the USA, there is NO NEED to purchase instruments ahead of time. Wait until after you come and we will fine-tune your needs during your visit.

With proper handling, sterile storage, and periodic (once or twice a year) maintenance by the manufacturer, a MadaJet provides wonderful service. Filled with your choice of anesthetic, a MadaJet can be used for ~5-7 patients before a refill (accomplished in ~30 seconds) is needed. And the same MadaJet can be used for as many cases as you have in a single day (I have performed as many as 34 vasectomies in a single day with one MadaJet). But after each day, the MadaJet should be emptied and sterilized by autoclave before the next day's use. So a MadaJet is most beneficial for a series of vasectomies and much easier to prepare than a whole bunch of pre-filled sterile syringes. But if you have just one case on a certain day, a needle and syringe are easier. So if you are using a MadaJet, plan to group your vasectomies on a certain day. And if you do that, perhaps you should have more than one set of NSV instruments, all sterilized and individually packaged, for "Vasectomy Days". I own 100 sets because my assiciate and I perform vasectomies at different "outfield" sites, sometimes during 3 consecutive days, during which we cannot re-sterilize our sets. I suggest that a vasectomist own at least 3 sets, perhaps more depending on your patient load and availability of staff to re-sterilize instruments while you work. If you have only one set, you need at least 20 minutes between patients to resterilize that one set. Or if you drop an instrument, it is nice to have a sterile replacement available.

So, here is what I recommend (These instruments can all be purchased at VasectomyStore.com, owned and operated by Advanced Meditech International):
1. A MadaJet and accessories, if you want to go with the no-needle technique.
2. 3 sets of VE-21 Standard NSV instruments. 
3. 3 VE-6 Medium Clip Appliers. and one box of VE-6-10 clips. VasectomyStore.com also sells a 6-clip per-cassette system (by Aesculap and Vitalitec) which I like less because partially-used cassettes cannot be autoclaved (they melt). Alternatively, one can order Weck clips directly from Teleflex HERE, product 523800, and Weck clip appliers HERE, product #523109. But it is easier to get them from VasectomyStore.com. Clip appliers and clips are EXPENSIVE. To avoid that investment/expense, you may just use suture ties (silk or polyglycolic acid [Vicryl/Polysorb]) for fascial interposition or vasal occlusion. You will learn both in this training program.
4. 3 straight Halstead mosquito clamps.
5. 3 Iris scissors. I include scissors because I sometimes choose to use a suture (rather than a hemoclip) for fascial interposition or to control a vessel. But you don't need a scissors for the vast majority of cases.
6. A box of Disposable Thermal Cauteries (batteries included) or a single Reusable Thermal Cautery Handle (ask for the "newer model") and 2 boxes of CT-2121 Vasectomy tips (you supply the batteries).

These supplies have been bundled by the VasectomyStore as their No-Needle, No-Scalpel Pack 5. Alternatively, you can purchase Pack 2 with the 6-clip per-cassette system for $50 less.

You may be able to purchase #4 & #5 from your local instrument supplier for less. But rest assured that AMI's (VasectomyStore's) quality is absolutely the best. I own 100 sets of these instruments, most from AMI, and I have never been disappointed with their service or quality. Don't be daunted by the expense. The instruments will pay for themselves very quickly when the word gets out that you do a no-needle no-scalpel vasectomy with virtually no pain and a quick recovery time.

You can buy all of these instruments with a credit card online before you come, and have AMI ship them to my office in Tampa/Lutz:

288 Crystal Grove Boulevard
Lutz, Florida 33548

If you are coming from outside the US, you can take them home in your checked baggage to avoid overseas shipping charges and taxes.

5. You may also wish to equip yourself with a pair of 2.5x optical loupes. I purchased my most recent pair from Designs for Vision, Inc. for $1345.00, and that included bifocal glass in my prescriptions. This may sound like a lot, but my most recent pair of prescription transition photo-gray glasses was over $550, over 1/3 the cost of the surgical glasses. For me, they are indispensable, so I purchased a second pair, the 3.5x loupes. I actually prefer the 2.5x pair because they are lighter, and the field of view is brighter, larger, and greater in focus depth. The working distance of 21 inches allows me to stand upright in good posture. The magnifiers are mounted into bifocals which provide me with good distance vision and reading-glasses type magnification around the 2.5x lenses, so I keep them on through a whole vasectomy day. They are so important to me that I keep a second 2.5X pair with my travel gear (for vasectomies outside my main office) so that I never have to worry about forgetting my home office pair when I travel. Even if you perform only a few vasectomies, they are also very useful for a wide variety of office tasks, including examining skin lesions and repairing or cleaning fine instruments.
If you don't want to spring for >$1000, get a simpler adjustable pair for $50 on Amazon or Ebay. Search "dental loupes". The optics are fine, but most of the inexpensive loupes have focal lengths of 420mm (16.5"), which is fine if you are short or have a height-adjustable exam table. But if you are tall and your procedure table cannot be raised, you will have to bend over to be at the proper focal length.

6. Before a hands-on session, a trainee usually finds it helpful to watch me perform a few vasectomies at my normal pace in order to appreciate the nice rhythm that develops in the course of doing a series of vasectomies. You may bring your digital or video camera and take photos of my office setup and of the procedures of men who provide permission. You are welcome to take samples of my brochures, consent form, op report, and patient instruction sheets. Some valuable training resources are also HERE.

7. If my staff forgets to ask, please let us know your surgical glove size so that we may have them available on your training day. I wear size 7. If that is your size, we will have no need to make a special order.

Now, 2 frequently asked questions:

1.How many cases should I perform under supervision before I start doing vasectomies on my own?

Trainees who have good fingertip sensation and fine motor skills are usually comfortable with most vasectomies (the easy men with thin skin and vas tubes of normal caliber) after 8 hands-on training cases. ALL trainees are MORE comfortable after 12 hands-on cases. So, after training, you screen the cases for the first few months and choose only the easiest ones for yourself, referring the rest to more experienced vasectomists. As you gain experience, you take on the more challenging cases. As they say, you must know your limitations. Even after 45,000 vasectomies, I find a few men quite challenging, so you will probably never reach the point at which every one is easy. During your training days, you will also observe and examine another 12-20 vasectomy cases. .

2. After the training, will I be able to handle complications?

Almost all surgical procedures involve the two classic risks: bleeding and infection. With vasectomy, "bleeding" usually refers to the development of a scrotal hematoma, large enough, on very rare occasions, to require a trip to the operating room for drainage. Urologists can already do this. Non-urologists may have to recruit the help of a urologist to help with this problem. "Infection" can be a mild soft-tissue infection treated with antibiotics, or an abscess, also very rare, requiring drainage by a urologist.

Other than bleeding and infection, the only other complications of vasectomy are failure, requiring a repeat vasectomy, and chronic post-vasectomy pain syndrome (PVPS), requiring referral to a urologic sub-specialist for vasectomy reversal or neurolysis.

So no, you may not be able to handle all complications, but even general urologists who perform vasectomies regularly sometimes need help with problems.

To discuss training, please call my office at 813-536-1430 any weekday or my cell phone at 813-390-3032 any evening until 9:30 PM Eastern Time. If you would like to discuss the training process with a former trainee, please request a trainee referral list via our Contact Us page. If you don't get a response within 2 days, please call one of the numbers above.

Thank you.