Orchidectomy - 3 types

scrotal, simple

1. Midline scrotal cut. Open the tunica. Deliver.
2. Stitch-ligate the vessels (0). Tie the vas (2/0).
3. Do not cut the tie till bone dry. A retracted cord is misery to find.

subcapsular, hormone shutdown

1. Same exposure. Slit the tunica lengthways.
2. Sweep the contents out with a swab.
3. Diathermy bleeders. Close the tunica.

radical inguinal, suspected cancer

1. NEVER take a tumour out through the scrotum.
2. Landmarks: ASIS and pubic tubercle. About 5 cm cut between them, along the line of the canal.
3. Skin. Camper's fat. Scarpa's fascia. Stop at the shiny external oblique.
4. Open external oblique along its fibres, through the external ring. Isolate and protect the ilio-inguinal nerve.
5. Clamp across the cord at the inner ring. Before the testis is touched.
6. Evert the scrotum with a finger. Deliver testis in its coverings. Divide the gubernaculum.
7. Second clamp. Divide above both clamps. Testis and cord are the specimen.
8. Transfix (0 Vicryl) between the clamps. Slowly off with the top clamp.
9. Transfix below the bottom clamp. Slowly off with it. Stump dry before it goes.
10. Prosthesis if wanted: down the groin route. Never a scrotal cut.
11. Close: external oblique 2-0 Vicryl continuous, nerve clear. Scarpa's 3-0 Vicryl interrupted. Skin 4-0 Monocryl subcuticular.