CPT® Code 55300

1. Indications

The vasotomy procedure is indicated for the following conditions:

• Vasogram A diagnostic imaging study to evaluate the patency and structure of the vas deferens.
• Seminal Vesiculogram An imaging procedure to assess the seminal vesicles, which are glands that contribute to semen production.
• Epididymogram An imaging study focused on the epididymis, the structure where sperm mature and are stored.

2. Procedure

The procedure for performing a vasotomy involves several detailed steps, which can vary depending on whether an incision is made in the vas deferens or not.

• Step 1: Identification of the Vas The scrotum is palpated to locate the vas deferens. This is crucial for ensuring that the correct structure is accessed during the procedure.
• Step 2: Incision (if applicable) If a vasotomy with incision is performed, a small incision is made in the skin of the scrotum. The vas deferens is then pulled up and delivered to the operative field for further manipulation.
• Step 3: Hemi-Vasotomy Creation A straight clamp is placed under the vas deferens, and a hemi-vasotomy incision is created using an operative microscope and a micro-knife. The clamp serves as a platform for this delicate procedure.
• Step 4: Fluid Collection Fluid may be obtained from the opening of the vas deferens for examination. This can be done in the operating room or sent to a laboratory for further analysis.
• Step 5: Cannulization The vas deferens is cannulized using an angiocath, which is inserted into the distal end of the vasotomy. Additional fluid samples can be obtained and examined or sent to the laboratory.
• Step 6: Injection of Contrast Media A syringe containing 5-10 mL of contrast media is attached to the angiocath. The fluid is injected to visualize the distal seminal duct under fluoroscopy, allowing for assessment of proximal patency of the vas deferens and epididymal tubule.
• Step 7: Closure of the Hemi-Vasotomy After the imaging is completed, the angiocath is removed, and the hemi-vasotomy is closed in layers. The skin is then closed to complete the procedure.
• Step 8: Bilateral Procedure (if applicable) If bilateral studies are required, the entire procedure is repeated on the opposite side to ensure comprehensive evaluation.
• Step 9: Non-Incision Technique (if applicable) If the procedure is performed without incision, the scrotum is palpated to locate a straight portion of the vas deferens. An angiocath or lymphangiogram needle is carefully threaded into the vasal lumen, and the procedure continues as described for the vasotomy with incision.
• Step 10: Post-Procedure Care Upon completion, the needle is removed from the scrotum, and firm pressure is applied to the puncture area to minimize bleeding. If bilateral studies are performed, the procedure is repeated on the opposite side.

3. Post-Procedure

After the vasotomy procedure, patients are typically monitored for any immediate complications, such as bleeding or infection. It is important to apply firm pressure to the puncture site to minimize bleeding. Patients may be advised to avoid strenuous activities for a short period to facilitate healing. Follow-up appointments may be scheduled to review the results of the imaging studies and to assess the recovery process. Any additional care instructions will be provided based on the specific circumstances of the procedure and the patient's overall health.