Scrotal orchiopexy option #1

  1. Position supine, prep/drap, antibiotics only if pubic hair requiring clippers
  2. Perform transverse incision over hemiscrotum, incise through underlying layers with cautery
  3. Expose testicle, remove further layers as needed
  4. Pexy lateral, medial, and inferior portions with 5-0 prolene
  5. Run dartos fascia with 4-0 vicryl
  6. Run horizontal mattress on skin with 4-0 chromic
  7. Bacitracin, fluffs, scrotal support

Scrotal orchiopexy option #2

  1. Once patient asleep, palpate for testis using KY jelly, may feel or see testicle pop back
  2. Make lateral scrotal incision in skin folds
  3. Insert Jake inferiorly with tips up, spread once inside, spread opening
  4. Insert hemostat superiorly with tips down, insert into ring, spread open then close gently and remove
  5. Keep grip on tissue and peel away fat, find testicle
  6. Continue to peel back fat and cremasteric fibers into ring
  7. Grab hernia sac with debakey, peel down vas and vessels from hernia sac
  8. Pass Gerald between sac and vas/vessels, grab and divide
  9. Stick tie hernia sac proximal end with 4-0 monocryl (use one stitch for entire surgery)
  10. Pexy inferior testis, then cut off needle from stitch
  11. Use keith needle to pass stitch through inferior scrotum (over butt end of adsons)
  12. Pass one end of stitch through skin using keith needle, then tie
  13. Close dartos with figure-of-eight stitch
  14. Close skin with monocryl subcuticular

Scrotal orchiopexy #3

  1. Place supine, prep/drape, no antibiotics needed if prepubertal
  2. Make transverse incision over hemiscrotum through rugae
  3. Identify and grasp testis, free up from surrounding dartos and cremaster tissue, taking care to not injure cord structures and obtain hemostasis throughout
  4. If hernia sac identified, can tie off
  5. Create subdartos pouch with hemostat
  6. Loosely close inguinal canal around cord with 3-0 vicryl to prevent retraction
  7. Secure testis into scrotum with 5-0 monocryl, pexy through dartos tissue in lower scrotum and a skived stitch through anterior upper testis
  8. Close dartos with 5-0 monocryl (taper) and skin (cutter), then apply dermabond

Inguinal orchiopexy

  1. Make incision w/ #15 scalpel in line from ASIS to pubic tubercle
  2. Dissect layers with electrocautery, hemostat, use S-retractors for exposure
  3. Expose external oblique and shelving edge with sharp dissection with Metz
  4. Make small incision on external oblique with scalpel, then open by pushing with scissors
  5. Use Debakey to push nerve and cord off fascia
  6. Expose testicle and use for traction, take down gubernacular attachments
  7. Identify sac, dissect free from vas/vessels using Debakey dissection
  8. Once hernia sac isolated, clamp w/ hemostat, cut w/ scissors, and stick tie with 3-0 vicryl
  9. Once enough length on testicle, dissect down to scrotum with finger
  10. Make incision in hemiscrotum over finger, dissect subdartos pouch with iris scissors
  11. Pass tonsil through incision up to inguinal incision via finger tract
  12. Grasp testicle (once oriented) and bring down to pouch
  13. Pexy testicle at inferior and medial sides with 6-0 PDS, do not buttonhole
  14. Close scrotal skin with 6-0 PDS as subcuticular
  15. Close external oblique with 3-0 vicryl, then place one scarpa’s stitch with 3-0 vicryl
  16. Close skin with “Coop’s stitch” x2 – pucker skin by going through dermis but do not buttonhole, brings edges together
  17. Cover scrotal and inguinal incisions with dermabond
  18. Discharge with tylenol and ibuprofen, RTC 6 weeks

Laparoscopic orchiopexy (one stage)

  1. Position in supine position
  2. Place OG and rectal tubes to maximally decompress intestines
  3. Empty bladder with catheter
  4. Feel for testicle location, feel for contralateral testicle
  5. Make small infraumbilical incision
  6. Dissect down with electrocautery, spread with hemostat
  7. Place retention stitch with 3-0 vicryl in young kids, 2-0 vicryl in school age
  8. bend CT-2 to be like UR-6 for 3-0 vicryl (2-0 comes on UR-6)
  9. Place 5mm trocar into abdomen, inspect with camera, look for intraabdominal testicle
  10. Place LQ trocar in contralateral side and UQ trocar on ipsilateral side using similar technique
  11. Examine abdomen, identify intestines, bladder, and assess for undescended testicle
  12. Assess for blood supply and vas length
  13. Using scissors and marilyn, free up attachments and blood supply to provide length
  14. Dissect medial to obliterated umbilical artery (medial ligament) to create window for testicle
  15. Make transverse incision over ipsilateral scrotum, dissect down a pocket
  16. Pass marilyn through abdomen and out through scrotum, grab 0 silk tie and bring through and through scrotum and abdomen
  17. From scrotal side, grab silk tie with marilyn and follow into abdomen
  18. Once inside abdomen, grab testicle and bring out through scrotum, keep snapped to prevent retraction
  19. Re-examine abdomen for bleeding, free up more attachments to decrease tension
  20. Pexy testicle into place with 3-0 PDS
  21. Reassess abdomen for bleeding
  22. Remove ports with stitch in place, use stitch to close fascia
  23. Close port sites with subcutaneous 4-0 vicryl, subcuticular 5-0 monocryl (if needed)
  24. Close scrotum with 5-0 monocryl subcuticular
  25. Cover with mastisol and steristrips, then bandaids