Certainly not. The vas tubes are most easily and safely divided under direct vision with a fine surgical scissors. But the expression "LASER" has great popular appeal, and use of laser energy in the performance of a simple vasectomy serves no purpose but to play up to this popular appeal. Lasers have proven indispensable for certain types of retinal (eye) and skin procedures, and they offer an alternative, though not necessarily better, means for destroying tissue (prostate and certain tumors) and kidney stones. But a laser (like any other form of light) cannot pass through opaque tissue without burning a hole in it, so a laser cannot be magically directed at internal organs such as the vas tubes without an access opening in the same way that sound waves can be used to destroy kidney stones without an incision. "An Update on Laser Use in Urology" in the October 2003 issue of Contemporary Urology by MJ Manyak and JW Warner from George Washington University Medical Center in Washington, DC did not even mention vasectomy as a potential laser application. The authors maintained that  with the CO₂ lasers used in office environments, "use is typically limited to surface applications because CO₂ laser energy is absorbed by water, resulting in a shallow depth of penetration (<0.1 mm). ... Because the CO₂ laser produces a plume that has the potential for vaporizing infectious viral particles, an appropriate fine mesh filtration mask must be used by all operating room personnel during all cutaneous procedures. Other drawbacks of the CO₂ laser include poor coagulation of vessels with a diameter greater than 1.0 mm and development of oxidized char that impedes vaporization of underlying tissue." So lasers play no role in a procedure as simple as vasectomy and introduce an unnecessary element of risk.  A recent search revealed no articles in the medical literature advocating use of a laser with vasectomy.

Some men ask, "Why not just use suture?"  Dr. Stein replies, "Yes, I could use a suture instead of a titanium clip, and that would be just as easy if I had 3 hands. The vas sheath is held closed with a hemostat (upper end inside sheath and lower end outside sheath) which I stabilize with my right hand as I apply the hemoclip with my left hand. It takes 2 hands to tie a suture. I could lay the hemostat down to free up both hands, but sometimes the tissue is fragile and is best handled very gingerly. I would be happy to give it a try for patients for whom avoiding the clips is very important. (In India, suture is always used because hemoclips are more expensive, labor in the form of assistants is very cheap, and patients don't ask that no one be in the room except for the doctor, as we sometimes hear from more modest Americans.)"

Dr. Stein has performed open-ended vasectomies exclusively since late 1990, and while there is some merit to this technique, the web pages lauding it are probably overstating the benefits.
First, not all open-ended vasectomies result in a sperm granuloma at the vasectomy site. Dr. Stein has reversed vasectomies for a number of his own vasectomy patients and learned that many of the lower ends simply end as a sealed tube with little or no surrounding inflammation. So a natural seal of the lower vas end must occur soon after an open-end vasectomy in many patients.
Second, some open-end vasectomy patients (about one in 50) will still develop post-vasectomy discomfort and tenderness of the epididymis. The likelihood of this occurring is lower with the open-end technique: 2% of patients as opposed to 6% of patients with the closed-end technique (Contraception 46(6):521-521, 1992). This "congestive epididymitis" usually responds quickly to an anti-inflammatory drug like ibuprofen, but serves as proof that an open-end technique is not a sure way to avoid post-vasectomy epididymal inflammation.
Third, a vasectomy site granuloma can be just as tender as epididymal inflammation, though it too usually responds quickly to anti-inflammatory drugs.
Fourth, while reversal success rates may be better after open-end vasectomies, performance of this technique is no guarantee of reversal success and many men with closed-end vasectomies have undergone successful reversals.

In summary, while an open-end technique offers theoretical benefits, use of it is not a "standard of care" and the closed-end technique has worked well for years.

The February 17, 1993 issue of the Journal Of The American Medical Association contained 2 studies (by the same research group) that suggest that vasectomy was associated with a small increased risk of prostate cancer in their study groups (almost 30,000 patients in 1 study and almost 40,000 patients in the other study).  Because the question was initially raised by 2 studies back in 1990, the World Health Organization convened a 1991 meeting of 23 international experts to review all research regarding vasectomy and prostate cancer.  They concluded that there was no plausible biologic mechanism for a relationship between vasectomy and prostate cancer.  Some medical researchers interpreted the small increased risk noted in the 1993 studies as a weak association that may be due to chance or bias.  A systematic review of the medical literature in 1998 (Fertility & Sterility, 70: 191) further documented the lack of a significant relationship between vasectomy and prostate cancer. Additional convincing evidence of no relationship has been published in the Journal of Urology in June 1999 (161: 1848-1853), in the Journal of the American Medical Association in June 2002 (287:3110-3115), in the Journal of Urology in October 2002 (168: 1408-1411), and in Fertility and Sterility in November 2005 (84:1438-1443). Because the question of a relationship has been raised, however, the American Urologic Association recommends that men who have had vasectomy and are over 40 have an annual rectal exam and prostate cancer screening blood test (PSA).  This is the same recommendation made by the AUA for all men of age 50-70.

The question of an association between vasectomy and subsequent cardiovascular disease was raised back in 1978 and 1980 by two studies which reported an increase in atherosclerosis (hardening of the arteries) in vasectomized laboratory monkeys. The last article listed above (Cancer and cardiovascular disease after vasectomy: an epidemiological database study. Fertility and Sterility 84:1438-1443, November 2005) provides an excellent bibliography of studies showing no association in humans as well as its authors' own data comparing 24,773 vasectomized men with 159,480 non-vasectomized men as a control group. Their findings "strengthen the evidence that vasectomy is not followed by an increased risk of myocardial infarction [heart attack], coronary heart disease as a whole, or stroke. In particular, we add strong support to the evidence that there is no elevation of risk of cardiovascular disease in men after long periods after vasectomy."

My office has copies of these and other research studies, available to any patient upon request.

Special Message for Young Men with Fewer than Two Children

If you are less than 30 years old and you have had fewer than 2 children, please consider the following points before having a vasectomy:

1. You may regret it. Men who have vasectomies when they are in their 20's, especially if they have had fewer than two children, may be the ones most likely to seek vasectomy reversal at a later date, often regretting their vasectomy decisions if their reversals are not successful.

2. You may change. Many men who think they will never want children when they are in their early 20's are delighted with fatherhood when they are in their 30's. You may be totally convinced now that you will never want children, but people change and you may have a much different outlook 10 years from now.

3. Women change. Similarly, women who have no desire for children when they are in their early 20's may have a much stronger desire when they are in their 30's and when many of their friends are having children of their own.

4. Relationships end. Since more than 50% of American marriages end in divorce, you may not be with the same partner ten years from now and a new partner may have a much stronger desire for children than your present partner does. So just because your present partner claims that she will never want children, her tune may change 10 years from now, or she may not even be your partner 10 years from now.

5. The philosophy of you and your partner with respect to abortion should be considered. If you are both not philosophically opposed to abortion, you have some back-up should other forms of contraception fail, and having a vasectomy now may not seem as critical to avoid an unintended pregnancy. But keep in mind that if she gets pregnant, the choice is hers.

6. Vasectomy should be considered a permanent and non-reversible procedure because vasectomy reversals are not always successful.

7. Young men should consider Sperm Storage. The companies who provide the service will send what you need directly to your home, you can collect the semen specimens in the privacy of your home, and you can mail them back to the company in the storage container provided. Imagine meeting a prospective partner years after your vasectomy. You fall very much in love with her, but you know that she will someday want children. You can tell her, "I have had a vasectomy", or you can say, "I have had a vasectomy, BUT I banked sperm for future use." Now, which do you think will sound better to her? In her eyes, either you did a foolish thing years ago, or you made a responsible decision with good foresight. In one case, you may lose the girl; in the other case, you win her heart. So sperm storage can be a very smart thing, well worth the investment.

Have you discussed your decision with your parents? If not, consider this: You're an adult, yes, but they helped you get there. How would you feel if your son came home one day and said that he had had a vasectomy? That he had done something to limit his future potential (to be a father) and to limit your own potential (to be a grandfather). How would you feel, after nurturing and guiding him for over two decades, if he did something to profoundly influence his future, but did not have the respect or courtesy to just tell you about it beforehand? As with many decisions in life, change the question from, "Should I tell my parents?" to "What can I do that I will never regret?" Would you ever regret not telling them? Probably, especially if they are hurt as I, as a parent, would be. Would you ever regret telling them? No. Having a vasectomy is still your decision, but at least you granted them the respect of letting them render an opinion. And if they succeed in discouraging you, because they know you better than any doctor does, you may one day thank them.

All of this said, I recognize the fact that most of us know someone whose girlfriend said she could not get pregnant, or conveniently "forgot" to take her pills, or even poked pinholes in his condoms. And I recognize that our judgments can be impaired after a few drinks so that we are less inclined to cover up or pull out on time. Indeed some men perceive the risks of not getting a vasectomy to be greater than the risks of getting one. We must all be masters of our own destinies, and that is easier if we think through all of the implications, alternatives, and potential consequences of our decisions.

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