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| CASE REPORT |
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| Year : 2020 | Volume
: 47
| Issue : 1 | Page : 51-52 |
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Radical orchidectomy – operative steps
RB Nerli1, Manas Sharma2, Priyeshkumar Patel2, Shridhar C Ghagane3, Neeraj S Dixit3
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 Submission | 07-Mar-2020 |
| Date of Acceptance | 30-Mar-2020 |
| Date of Web Publication | 23-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
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jss.JSS_15_20
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 |
| Introduction | |  |
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.
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 | | |
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
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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
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Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 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.  [ 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. |
| 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. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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