Quentin Ducrot, Boris Delaunay, Ahmed Mansouri, François Isus, Michel Soulié, Éric Huyghe
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引用次数: 0
Abstract
Introduction: No-scalpel vasectomy (NSV) is a minimally invasive technique that is still not widely used in France, despite being recommended by the WHO and professional societies. The objective of this study was to examine its learning curve.
Methods: We prospectively analyzed the surgical and postoperative data of a cohort of 398 consecutive patients who underwent surgery under local anesthesia during the transition of our practice from traditional vasectomy to NSSV (the last 199 patients operated on using the traditional technique, and the first 199 patients operated on using NSSV). The procedures were performed by two andrologists at a university center. Operating time was analyzed for the last 50 traditional vasectomies compared with the first 50 VSBs to establish a learning curve using the CUSUM method. Patient satisfaction with the procedure was assessed using a 1-to-5 Likert scale.
Results: The mean age in our series was 39.7±6.9 years. A total of 84.8% of patients were in a relationship. The primary motivation was shifting the burden of contraception in 57% of cases. Sixty-five patients (16%) were childless. Operating time was shorter in the VSB group (14.6 vs. 21.5min) and decreased to an average of 9.4min for VSB after the 38th procedure. The peak of the learning curve occurred between the 10th and 21st procedures, depending on the surgeon. Patient satisfaction was higher for VSB (P-value=0.002). There was a non-significant trend favoring VSB regarding the rate of surgical complications (2 vs. 4 Clavien 3 complications). Efficacy was similar (98.4%).
Conclusion: VSB reduces operative time compared to the traditional technique. It is quick to learn, and both patient tolerance and efficacy remain good even while surgeons are still learning the technique. It helps meet the growing demand for vasectomies and optimize operating room utilization. Optimization of the technique continues beyond the 40th procedure, but this number is quickly reached due to the short operative time and current high demand.
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