Vasectomy methods vary by country as well as by physician. Regardless of method, the vas deferens is accessed through the scrotum. First, the skin is anesthetized with lidocaine. This is accomplished no-needle with the use of an injector that sprays the anesthetic straight through the skin (Madajet). This typically feels like a "flick" from a rubber band.
We are able to use the Madajet because the opening in the skin is very small and made without a scalpel. We accomplish this by using a small, very sharp tool known as a dissecting forcep.
The vas is clamped with a ring clamp and brought out through the skin. It is carefully, but quickly, separated from surrounding tissue.
A thermal cautery tool is used to make a small opening in the tube and then the inside of the tube is heated. The cautery tool is then used to separate/cut the two ends of the vas deferens. The abdominal end drops back into the surrounding tissue. The surrounding tissue is picked up and closed with a suture or inert titanium clip as seen below.
The other end of the vas is cut and left open (open-ended vasectomy). After it is noted to be free of bleeding it is dropped back into the scrotum. The other vas deferens is then brought up to the same opening (only one opening in the skin) and the procedure is repeated. The procedure is now complete. The opening is small enough that it does not require any suture or closure.