inguinal canal and orchidectomy

Inguinal Canal

Anatomical Landmarks 

Inguinal Orchidectomy Illustration

A para-inguinal incision is made 2 cm above the inguinal fold from the pubic tubercle toward the superior anterior iliac spine. A 5–6 cm incision is usually enough.

The spermatic cord is isolated at the external inguinal ring.

The index fingers of both hands are introduced along the spermatic cord down to the testicle to detach the scrotal skin from the distal spermatic cord and the proximal testicle in an avascular plane.

The testis, covered by its tunics, is brought outside the scrotum by a combined pushing of the testis from below and drawing of the spermatic cord upward.

The vaginoscrotal ligament, or gubernaculum testis, is divided and ligated. The testis is free and can be inspected and palpated carefully outside the inguinal incision.

If the diagnosis of testicular cancer is uncertain, the operative field is protected with surgical sponges, the spermatic cord is clamped and a biopsy is taken for intraoperative frozen-section histological analysis.

The procedure is performed under general, psinal or local anesthesia on an outpatient basis. 

The patient is placed in the supine position with the scrotum prepped in the sterile field. 

a 5 to 7 cm oblique incision is made in the inguinal area along langerhans skin lines approximately 2 cm above the pubic tubercle. 

This incision can be extended onto the upper scrotum to facilitate removal of large tumours. 

Camper’s and Scarpa’s fascia are incised to the level of the external oblique aponeurosis. 

External oblique aponeurosis is incised in the direction of its fibers to the level of the internal ring. 

The ilioinguinal nerve is identified, dissected free of the cord, and preserved. 

The spermatic cord is isolated and either occluded with a non-crushing clamp or a 0.5-inch Penrose tourniquet at the level of the internal ring. 

The tests and its investing tunics are delivered into a carefully draped off fiield as gubernacular attachments are divided. 

If a diagnositc biopsy or subtotal orchiectomy is planned, meticulous draping off is necessary befroe opening the tunica vaginalis and incising testicular parenchyma. 

Radical orchiectomy is completed by mobilising the cord 1 to 2 cm inside the internal ring and individually ligating the vas deferens and the cord vessels between separate clamps 

The cord vessels are secured with silk ligatures, which can then be used to identify the stump if a retroperitoneal lymph node dissection is performed. 

the wound and scrotum are thoroughly irrigated, and homeostasis is secured. 

A testicular prosthesis can be placed at this time. 

The external oblique aponeurosis is clsoed with a running 2-0 Prolene suture. 

Scarpa’s fascia is closed with absorbable sutures and the skin with either skin staples or a subcuticular sutures. Compressive fluff dressings iwth a scrotal support minimize postoperative edema.