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- Patients may be administered spinal, general, or (uncommonly) local
anesthesia. Shave the inguinal area, and prep in a standard fashion.
- Create an inguinal incision to allow exposure of the external and internal iliac canal.
- Open the external iliac fascia, exposing the spermatic cord and internal iliac canal. Control the spermatic cord with a Penrose drain in a tourniquet fashion to stop retroperitoneal lymphatic and venous drainage of tumor cells.
- Then, deliver the testis from the scrotum and ligate separately the vas deferens and spermatic arteries.
- Leave a long nonabsorbable tie on the patient side of the spermatic cord. This is to facilitate identification if retroperitoneal lymph node dissection
(RPLND) becomes necessary and the patient requires dissection of the remaining spermatic cord structures from the abdominal exposure.
- Reapproximate the external oblique fascia and close the skin in standard fashion.
Postoperative details
- Radical orchiectomy is usually performed on an outpatient or 23-hour admission basis, often accompanied by the staging workup.
- Conduct a follow-up study on the patient by staging and referring him for appropriate adjuvant therapies.
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Complications rarely are a problem but may include
- wound infection,
- inguinal skin numbness from injury to the genitofemoral nerve,
- haematoma
- standard anaesthetic risks.
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