DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left testicular mass.
POSTOPERATIVE DIAGNOSIS: Left testicular mass and left hydrocele.
OPERATION PERFORMED: Left orchiectomy.
SURGEON: John Doe, MD
ANESTHESIA: General.
DRAINS: None.
TUBES: None.
ESTIMATED BLOOD LOSS: 5 mL.
SPECIMENS REMOVED:
1. Left testicle.
2. Distal spermatic cord.
COMPLICATIONS: None.
POSTOPERATIVE CONDITION: Stable.
OPERATIVE FINDINGS: The patient did have an indurated left testicle, which was larger than his right testicle. This was removed without difficulty along with distal spermatic cord, which was ligated proximally.
DESCRIPTION OF OPERATION: The patient was brought back to the operating suite by the OR and anesthesia staff and was placed on the operating room table. The patient was smoothly induced with anesthetic and intubated without difficulty. The patient’s lower abdomen and genitals were then prepped and draped in a sterile fashion.
A small, approximately 4 to 5 cm transverse incision was made in the left lower abdomen over the spermatic cord. A 15 blade was used for the initial incision, and electrocautery was used to dissect down to the external oblique fascia. The external oblique fascia was then incised with a 15 blade, and a Metzenbaum scissor was used to connect incision down to the external inguinal ring. This was approximately 5-6 cm in length. We also extended this incision up the external oblique fascia, so that the total incision was approximately 7 cm.
Using blunt dissection, we were able to isolate the left spermatic cord. This was encircled with Penrose drain, and conscious effort was made to identify the left ilioinguinal nerve and preserve its continuity. At this point, right angle was used to separate the contents of the spermatic cord into approximately four pieces, which were all clamped with hemostats, cut and ligated with silk suture. This thus was our high ligation of the spermatic cord, and attention was turned down to the testicle and scrotum.
At this point, the distal spermatic cord was freed from its attachments near the pubis, and the testicle itself was delivered onto the operative field by pressure from below. Once the testicle was in our operative field, electrocautery was used to dissect the scrotal skin away from the testicle to completely free it from all attachments. This was completed, and the testicle was then sent to pathology for permanent sectioning. Hemostasis was achieved with electrocautery, and Ray-Tec was placed in a container with 1% lidocaine with epinephrine. This soaked Ray-Tec was then inserted down through the incision into the tract from which the testicle was delivered. This was kept in place for approximately 1 to 2 minutes for better hemostasis in the scrotum.
Two interrupted 3-0 stitches were placed bringing together external oblique muscle distal to the spermatic cord, so that it would not be able to migrate distally. Once this was performed, a 3-0 running Vicryl suture was used to close the external oblique fascia, 3-0 pop-off Vicryl interrupted sutures were used to close Scarpa’s fascia, and a 4-0 running subcuticular Vicryl suture was used to close the skin. Dermabond was applied topically over the incision. Fluffs and scrotal support were applied to the patient. The patient was awakened from anesthesia and transferred to the PACU for postoperative resuscitation.
