b. Patient Preparation. The patient is placed in supine position and draped
with fenestrated sheet.
c. Operative Procedure.
(1) An anterolateral incision is made in the skin of the scrotum over the
hydrocele mass, using a scalpel with a number 2-0 blade. Bleeding is controlled with
Crile hemostats and vessels ligated with number 2-0 plain gut ligatures.
(2) Small retractors may be placed (see figure 3-10 A), and then the fascial
layers are incised to expose the testis and tunica vaginalis. With fine scissors and
forceps, the sac is delivered and dissected free (see figures 3-10 B and C). The
hydrocele may be aspirated. The adherent tunica vaginalis is separated from the
internal fascia layers and the sac opened. When the tunica vaginalis has been trimmed
as desired, the testis is returned to the scrotal sac.
(3) A Penrose drain is placed, and the wound is closed (see figure 3-10 D)
in layers with Atraumatic sutures plain gut number 2-0 on curved cutting needles. The
wound is dressed, and a supportive sling dressing or suspensory is usually applied.
3-32. VASECTOMY
a. General. This operation involves the excision of a section of the vas
deferens. This is done electively as a permanent method of sterilization or birth control
and also prior to prostatectomy to prevent spread of infection from the urethra to the
epididymis.
b. Patient Preparation. The patient usually lies in the dorsal supine position,
although the operation can be done in the lithotomy position prior to transurethral
surgery. The procedure may be done with either local or general anesthesia.
c. Operative Procedure.
(1) The vas is located by palpation in the upper part of the scrotum. A small
incision is made in the skin over the vas (see figure 3-11 A).
(2) An Allis forceps is inserted to grasp the vas and bring it to the surface of
the wound (see figure 3-11 B). The vas is denuded of surrounding tissues of the cord,
and straight clamps are placed on either side of the Allis to crush the vas.
(3) The vas is cut between the clamps and a section removed (see figure
3-11 C). The cut ends are doubled back and ligated with silk-or cotton number 3-0.
(4) The clamps are removed, and the skin incision is closed with plain gut
#3-0 on a needle. Acollodion dressing and scrotal suspensory may be applied.
MD0928
3-33
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