Right Radical Orchiectomy Operative Sample

DESCRIPTION OF OPERATION:  The patient was taken to the operating room, and under general anesthesia in supine position, his lower abdomen and genitalia were prepped and draped out in the usual manner. Lower quadrant was exposed. Ancef 1 gram IV piggyback was given prophylactically. I was able to place my finger in the right hemiscrotum and up to the inguinal ring and note this on the lower abdomen. A 3 inch incision was made, slightly obliquely, approximately 1 cm above the pubic tubercle and just proximal to the apparent external ring opening. This was carried down through subcutaneous tissue to the aponeurosis of the external oblique. Hemostasis was achieved with electrocautery. Through blunt and sharp dissection, dissection with electrocautery, I mobilized the aponeurosis clear. The external ring was noted. At this point, I made a small incision up in the fascia just proximal at the external ring and placed a Metzenbaum in it distally and out into the ring. I then incised the fascia over this. The inguinal nerve was noted and kept out of harm's way. The cord was then mobilized bluntly with a peanut and isolated with a 1/4 inch Penrose drain, double wrapped to prevent any proximal tumor spread. The testicle was then delivered into the wound under manual pressure. Its attachments to the scrotal wall internally were separated with blunt dissection and electrocautery. Excellent hemostasis was achieved and there was no evidence of any injury to the scrotal wall. The testicle and cord were then mobilized further proximally and the testicle clamped proximally. The testicle and cord were then sharply excised and passed off of the table. The stump was then suture ligated twice with 0-silk and one tie of 0-silk free tie. A piece of silk was left for future identification, if needed, during any further surgery that the patient may need. After assuring excellent hemostasis, the wound was thoroughly irrigated with no evidence of any bleeders. There is no evidence of any bleeding within the scrotal sac. The aponeurosis of the external oblique was then approximated with interrupted 2-0 PDS suture closing the opening up to the external ring. The subcutaneous tissue was closed with one layer of interrupted 3-0 chromic suture. It was then closed with running 3-0 chromic. The skin was approximated with stainless steel clips. A dry surgical dressing was applied. A soft dressing was applied against the right hemiscrotum and held in place with an athletic supporter. The patient tolerated the procedure well. The needle, sponge count, and instrument counts were correct at the end of the procedure. The patient was then transferred to the recovery room in stable condition.