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Scrotal Exploration for Testicular Torsion

What is this procedure?Tap to read

Testicular torsion: the testicle twists on its cord and cuts off its own blood supply. It is an emergency; the longer it stays twisted, the more likely the testicle dies.

How it is done: the surgeon opens the scrotum, untwists the testicle and checks whether it pinks up. If it is alive, it is stitched in place (orchiopexy). The other testicle is stitched in place too, so it can't twist later.

If the testicle is dead: it is removed (orchiectomy) and sent to pathology.

Key points

Supplies

Open

  • Minor pack, general instruments
  • Pediatric laparotomy drape, blue towels
  • Grounding pad
  • 4-0 Prolene to fix the testicles
  • Closure: 2-0 Vicryl SH; 3-0 Monocryl PS-2
  • Warm saline, 1000 mL
  • 4×4s, Kerlix fluffs
  • Athletic supporter, large
  • Bacitracin
  • Razor and lubricating jelly (for the shave)

Available in room, open only if asked

  • Penrose drain, 1/4 inch
  • If the testicle is removed: additional 2-0 Vicryl SH

Gloves

Anesthesia

  • General anesthesia.
  • Perioperative antibiotics: cefazolin (Ancef) 2 g IV, unless contraindicated.

Positioning

  • Supine.
  • SCDs on.

Prep and drape

Cautery

  • Grounding pad on.
  • Valleylab 30/30.

Specimen

  • Only if the testicle is removed: to pathology in formalin.

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