Orchiectomy (1)

Prep:
1) Verify both testes are present in the scrotum

2) Clip & prepare caudal abdomen & medial thighs

(avoid clipping to close to scrotum)

3) Flush prepuce w/ dilute betadine or chlorhexidine

4) Scrub 3 X alternating btwn betadine & alcohol

5) Drape to exclude the scrotum & center @ pre-

scrotal area
- Cranial drape is at mid-prepuce
- Caudal drape is at cranial aspect of scrotum

6) Count sponges before procedure

Incising:
1) Apply pressure on the scrotum to advance one testicle into pre-scrotal area

2) Incise skin and subcutaneous tissue along the median raphe over ventral midline of testicle. Length of
this incision is as long as testicle.

3) Continue the incision through the spermatic fascia to exteriorize the testicle. You will then see the
white parietal tunic.

4) Using pressure deep to the testicle – pop the testicle out of the incision using fingers.

5) The scrotal ligament is disrupted at the caudal aspect of the testicle using a gauze sponge.

6) Tearing the ligament facilitate spasm of the vessels and minimizes the risk of scrotal hematoma
formation after surgery.

7) Adipose tissue is cleaned off the spermatic cord & remaining adipose is pushed up toward testicle.

8) Incise the parietal vaginal tunic over the testicle.

a. Use #15 blade over cranial aspect of testicle.
b. DO NOT incise the tunica albuginea b/c this will expose testicular parenchyma.

9) Using Metzenbams, place into the incision & extend over spermatic cord & down to the body wall.

10) Peal back tunic to expose pampiniform plexis, ductus

deferens & associated artery, & cremaster muscle.

11) Fenestrate mesorchium (btwn cremaster & vascular

pedicles).
 Orchiectomy (2)
Removing the testes:

1) 3 Clamps are placed (handles facing assistant)

2) Vascular Pedicle is ligated w/ 2-0 monofiliment PDS.

a. The suture is placed below & above the clamp
closest to the body wall & the first throw is tied
(Remove the clamp before seating this throw).
b. ‘Flash’ the second clamp to help w/ securely
seating the knot. Do 2 throws (square knot),
before replacing the clamp. Then do 2 more
throws (4 total)
c. Cut suture ends 2-3 mm long.
d. A second ligature is placed on the vascular
pedicle (superficial or deep to the previous
ligature but put it 4 mm away from previous
ligature). Use hand or instrument ties.
e. Second clamp is flashed during the first 2
throws.
f. Cut suture ends 2-3 mm long.
g. Cut pedicle between the two clamps.
h. Grasp vascular pedicle w/ thumb forceps above the knot to prevent trauma. Check for
hemorrhage & replace.

3) Ligation of cremaster and tunic (caudal aspect of the spermatic cord):

a. Use 3 clamp technique but do only 1 ligature b/c of small size of pedicle.
b. Remove 3rd clamp & seat ligature into clamped area that remains. Flash the 2nd clamp during
the first 2 throws, return clamp, do last 2 throws.
c. Cut pedicle btwn two clamps.
d. Grasp pedicle w/ thumb forceps above the knot to prevent trauma. Check for hemorrhage &
replace.

4) Advance second testicle into incision, incise fascial covering & move testicle into incision. Repeat 1-3.
 Orchiectomy (3)
Closing:
1) Subcutaneous – 3-0 PDS, deep or buried knot. (3 separate
think layers of fascia – far, middle, & near)
a. First bite is deep to superficial – second bite is
superficial to deep.
b. Tie knot in a parallel fashion to the incision (allow knot to
seat deeper). 4 throws.
c. Cut suture ends 2 mm long – SQ is continued using
continuous pattern taking bites into all 3 layers of SQ.
d. BE CAREFUL not to take too deep of a bite in the
central portion because the urethra lies deep to
this area.

2) Skin is closed via interdermal, 4-0 Vicryl

a. Begin deep to superficial & then superficial to deep
b. Tighten knot parallel to incision & cut suture end right above knot to prevent ends from
sticking out of incision.
c. Continuous intradermal pattern – the bites must be
even distance & equal depth.
d. Bites on opposite sides of incision begin at the site
opposite of where the other one left off.
e. Do NOT grasp skin using thumb forceps.
f. Begin burring knot w/ 7 to 10 mm left in the
incision.
g. A bite is taken from superficial to deep then deep to
superficial perpendicular to the incision – loop is
pulled up (has 2 deep ends).
h. Suture material is advanced to the other side of the
incision & superficial to deep bite is taken.
i. Now the deep end is tied to the loop (deep/deep
origin) – producing buried knot.
j. 4 throws (parallel to incision) are completed.
k. Cut ends of suture material close to the knot.
l. The needle is then rethreaded into the incision
and exited 1cm laterally. Then pull it - seats the
knot.
m. Cut suture material at the skin.

3) Appose the incised dense fascia on either side of the penis with interrupted or cutaneous sutures.
4) Close subcutaneous tissues with a continuous pattern
5) Appose skin with an intradermal, subcuticular or simple interrupted suture pattern.