DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: History of testicular torsion.
POSTOPERATIVE DIAGNOSIS: History of testicular torsion.
OPERATIONS PERFORMED:
1. Midline scrotal mass excision.
2. Left orchiectomy.
3. Left testicular implantation.
4. Right orchidopexy.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
IV FLUIDS: Normal saline, 1 liter.
ESTIMATED BLOOD LOSS: Ten mL.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: After risks and benefits were explained and informed consent signed, the patient was taken back to the operative suite where he was placed in the supine position. The patient’s genitals were prepped and draped in the sterile fashion. Following this, using a 15 blade scalpel, the midline scrotal mass that was seen on palpation was excised. This was a very small, roughly 0.6 cm in size, circular hard mass that was sent for pathology, which was consistent with a sebaceous cyst. Attention was then turned to the patient's left inguinal area. A subinguinal incision using a 15 blade scalpel, roughly 2 cm in size, was made. The skin was excised, and using Adson pickups and electrocautery, I excised to the Camper's and Scarpa's fascia down to the level of the external oblique finding the external ring with the spermatic cord. We dissected around the spermatic cord using Metzenbaum scissors, as well as DeBakey forceps and a right angle. After excising around the spermatic cord, the spermatic cord was then withdrawn and the left testicle was brought through the incision site onto the patient's lower abdomen. Using Kelly clamps, this area was clamped off, and using electrocautery, we excised and allowed for hemostasis at the spermatic cord site. Using 4-0 chromic, we tied off all areas of venous bleeding and attention was turned to his spermatic cord. We used Metzenbaum scissors to dissect free his left testicle and then using first a 2-0 Vicryl tie as well as 2-0 stick-tie, we ensured hemostasis was obtained at the remaining spermatic cord.
We then turned our attention to ensure that hemostasis was obtained using electrocautery, and then using testicular implant, we cleansed the area with antibiotic solution. His testicular implant was inflated and all bubbles were removed. This was then sutured down to the scrotal wall using Allis forceps to bring this area of the scrotal wall to the surface of the incision site. Using a 5-0 chromic, this was then attached ensuring that this suture had gone through the patient's skin. The surgical implant was then reinserted through the scrotum and positioned correctly. For closure of the incision site, the external spermatic fascia was closed using interrupted 3-0 chromic with Camper's and Scarpa's fascia reapproximated using the same interrupted 3-0 chromic. The area was then cleansed with wet and dry. For closure of the skin, a 4-0 running Monocryl was used. This was then covered with Dermabond for closure. For the patient's midline scrotal incision, this was used for his right orchidopexy. This was accomplished using dissection using blunt forceps as well as hemostat to ensure that the patient's hydrocele sac was reapproximated. This was stitched and approximated to the dartos fascia using interrupted 5-0 PDS. Three stitches were placed to ensure that orchidopexy would take and then the skin was closed using a running 4-0 Monocryl. This was then closed and covered with Dermabond. The patient was then awoken from anesthetic and transferred back to PACU. While in the PACU, all questions were answered.
