Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 47  |  Issue : 1  |  Page : 51-52

Radical orchidectomy – operative steps


1 Department of Urology, JN Medical College, KLE Academy of Higher Education and Research; Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India
2 Department of Urology, JN Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
3 Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India

Date of Submission07-Mar-2020
Date of Acceptance30-Mar-2020
Date of Web Publication23-Jun-2020

Correspondence Address:
Dr. R B Nerli
Department of Urology, JN Medical College, KLE Academy of Higher Education and Research, JNMC Campus, Belagavi - 590 010, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.JSS_15_20

Rights and Permissions
  Abstract 


A radical orchiectomy is one aspect of the definitive treatment of testicular cancer. Testicular cancer generally affects young men between puberty and about 40 years. Successful treatment incorporates a number of modalities, including radical orchiectomy, retroperitoneal lymph node dissection, chemotherapy, and radiation.

Keywords: High inguinal, radical orchidectomy, testis cancer


How to cite this article:
Nerli R B, Sharma M, Patel P, Ghagane SC, Dixit NS. Radical orchidectomy – operative steps. J Sci Soc 2020;47:51-2

How to cite this URL:
Nerli R B, Sharma M, Patel P, Ghagane SC, Dixit NS. Radical orchidectomy – operative steps. J Sci Soc [serial online] 2020 [cited 2020 Jul 7];47:51-2. Available from: http://www.jscisociety.com/text.asp?2020/47/1/51/287480




  Introduction Top


The first step in the diagnosis of a testis cancer [Figure 1]a and [Figure 1]b includes ultrasonography of the scrotum and estimation of serum tumor markers (beta-human chorionic gonadotropin, alpha-fetoprotein, and lactate dehydrogenase). The standard-of-care for the removal and treatment of testis cancer includes a radical inguinal orchiectomy.[1],[2] This is the most common operation performed for testis cancer worldwide.
Figure 1: Enlargement of the right testis

Click here to view


For stage I non-seminomatous tumors, the treatment includes radical orchiectomy and retroperitoneal lymph node dissection, and the 5-year survival rate is 96%–100%.[3] For low-volume stage II disease, which is treated with radical orchiectomy and chemotherapy, the 5-year disease-free survival rate is 90%. For bulky stage II disease, which is treated with radical orchiectomy followed by chemotherapy and retroperitoneal lymph node dissection, the 5-year disease-free survival rate is 55%–80%.


  surgical Technique Top


An incision 2 cm [Figure 2]a superior and parallel to the inguinal ligament, following the line connecting the internal and external rings, is made. However, if the testicular mass is too large to be delivered through this incision, then the incision is extended toward the scrotum. The incision is continued through the subcutaneous fat and the Camper and Scarpa fasciae. The external oblique fibers and external inguinal ring are identified. An incision along the direction of the fibers from the external inguinal ring is made. The ilioinguinal nerve is identified and mobilized so as to separate it away. The two leaves of the external oblique fascia are separated so as to free the spermatic cord along its length.
Figure 2: (a) An incision 2 cm superior and parallel to the inguinal ligament. (b) The spermatic cord is isolated at the pubic tubercle. (c) The testis along with its coverings delivered. (d) The cord structures clamped at the deep inguinal ring

Click here to view


The spermatic cord is isolated at the pubic tubercle [Figure 2]b. The cord structures are clamped either with a Penrose drain secured tightly around it to form a tourniquet or with artery forceps [Figure 2]d. The testis along with its coverings are delivered [Figure 2]c into the inguinal region by blunt dissection at the level of the point of entry into the scrotum. The gubernaculum is then clamped, divided, and ligated.

The posterior wall of the inguinal canal is dissected to identify the inferior epigastric vessels [Figure 3]a. These vessels are clamped, divided, and ligated. The gonadal vessels [Figure 3]b are similarly clamped, divided, and ligated in the retroperitoneal area above the level of the internal ring. The vas along with its vessels is dissected up to their entry into the retroprostatic area. The vas is clamped, divided, and ligated [Figure 3]c. The testis along with the cord structures is delivered out of the operative field [Figure 4]. The wound is inspected, especially the scrotum for adequate hemostasis. The external oblique fascia and external ring is closed in a running fashion, The Scarpa fascia is opposed in an interrupted fashion, and the skin approximated with subcuticular sutures.
Figure 3: (a) Inferior epigastric vessels clamped, ligated, and divided. (b) Gonadal vessels clamped, ligated, and divided. (c) Vas deferens clamped and divided

Click here to view
Figure 4: (a) Excised specimen. (b) Testis cut open to reveal the tumor

Click here to view


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Nerli RB, Ajay G, Shivangouda P, Pravin P, Reddy M, Pujar VC. Prepubertal testicular tumors: Our 10 years experience. Indian J Cancer 2010;47:292-5.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Nerli R, Shukla A, Hiremath M. Benign testicular tumors in children: Testicular preserving surgery. In: Pediatric Cancer. Dordrecht: Springer; 2012. p. 281-7.  Back to cited text no. 2
    
3.
Hotte SJ, Mayhew LA, Jewett M, Chin J, Winquist E; Genitourinary Cancer Disease Site Group of the Cancer Care Ontario Program in Evidence-based Care. Management of stage I non-seminomatous testicular cancer: A systematic review and meta-analysis. Clin Oncol (R Coll Radiol) 2010;22:17-26.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
surgical Technique
References
Article Figures

 Article Access Statistics
    Viewed28    
    Printed0    
    Emailed0    
    PDF Downloaded9    
    Comments [Add]    

Recommend this journal