Once adequate local anesthesia has been achieved, with the original technique described by Shunqiang Li (see Footnote 3), a ring clamp is used to secure the vas , including the thin skin overlying the thin Asian vas. With the thicker Caucasian or African American skin , we now prefer to make a single midline puncture hole directly over the vas using one blade of the vas dissector, which is a sharp, curved hemostat with the serrations filed off (Fig. 8.3). A small hole is developed by placing the closed dissector into the hole made with the single blade and spreading, thereby pushing vessels aside and creating a hole large enough to introduce the ring clamp vertically (Fig. 8.4). The ring clamp is introduced through this hole and the vas grasped within it and then delivered. The vasal sheath is punctured with one blade of the dissecting clamp and the vas cleanly delivered, excluding the vasal vessels and nerves. The vasal vessels are gently swept away from a 2 cm segment of vas by vertically opening the blades of the dissecting clamp (Fig. 8.5). The vas is hemi-transected with electrocautery in two places, approximately 1 cm apart. Intraluminal cautery is performed on both ends, and the wire tip is rotated for approximately 10 seconds to ensure a 360° mucosal cautery burn (Fig. 8.6). A hemoclip is gently placed on the testicular end of the vas to prevent sperm leakage and granuloma formation until the cautery causes fibrosis of the lumen. The hemi-transection of the abdominal end of the vas is taken to completion, and the abdominal end is allowed to retract into the vasal sheath. The sheath is grasped and sealed over the abdominal end with a hemoclip, thereby accomplishing fascial interposition (Fig. 8.7). The intervening vas segment is excised and the vasal ends are pulled into the scrotum by gently pulling on the testicle.