4.1 Surgical Technique
The closed inguinal approach is performed under general anaesthesia and
strict aseptic conditions (disinfection, draping, using gloves and gowns
etc.). A 5-10 cm skin incision is made over the palpable outer inguinal
portal. The underlying vaginal process, containing Testis, Epididymis,
Ductus deferens, testicular artery and vein forming the Plexis
pampiniformis distally and their mesenteries, is approached by strict
blunt dissection using Mayo scissors in spreading fashion and digital
separation of tissue. The vaginal process is hooked by a finger and
retrieved by gently pulling and some pushing on the scrotum. The
remaining attachment to the scrotum by remnants of the Gubernaculum is
separated by disruption. A Sand emasculator is applied to the closed
proximal process at the level of the skin incision and the crushed site
(Fig.1) is ligated with a double strand nr.4 metric Polyglactin 910,
which both, ligates vascularity and closes the vaginal cavity
permanently. The distal part of the vaginal process including content is
cut by scissors 10 mm distal to the ligature and the combined weight of
the left and right removed tissue was measured. The proximal vaginal
process including pedicles is checked for haemorrhage and released. The
skin wound is closed by Nr.3 metric Polyglactin 910 or Nr. 3 metric
Poliglecaprone 25 in a double layer sub- and intra-cutaneous continuous
suture and sealed by a sterile wound spray (CE 0124, Beiersdorf).