The patient is consented for bilateral
exploration, bilateral orchidopexy and orchidectomy.
GA. Supine. IV abx. TEDS. SCD. Time out. Sterile prep and drape or
Perform a median
raphe incision cutting through skin using
Displace testis medially so that soft tissues on
the appropriate side are divided using diathermy including
dartos, external spermatic fascia, cremasteric fascia,
internal spermatic fascia.
Cautiously open the parietal layer of tunica
vaginalis by picking it up between two artery forceps and
widen the incision to deliver the testis.
Viewed from below an anti-clockwise rotation is
required for the right side and a clockwise rotation for the
left side – away from midline somewhere between 180-720
If the testis is dusky or black, it is placed in
a sponge moistened with warm saline and left for 10 minutes.
If after this the testis remains black, then an
orchidectomy is required. Clamp the cord with two large
arteries. Double tie the proximal cord with 0 Vicryl
transfixing suture and then 0 Vicryl tie. Then cut the cord
leaving both ties. The contra-lateral
exploration and fixation is then required.
If the testis is viable then perform bilateral
To perform fixation, I use a 2/0 prolene suture.
I evaginate the scrotum and place a suture in the parietal layer of tunica vaginalis and
then a suture in corresponding place in testis
( taking care not to penetrate deeply).
Place 3 sutures, one at lower pole, one at right and left sides.
Tie all sutures only after placed.
Through the same incision dissect into the
contrelateral sac and perform fixation as above
If torted appendix testis or epididymis then
place a 2/0 Vicryl tie and excise.
If epididymitis, then washout with saline
Closure in layers with 2/0 Vicryl to tunica
vaginalis, continious 2/0 Vicryl to dartos and interrupted 3/0
Monocryl to skin.