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).