DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Left spermatocele.
POSTOPERATIVE DIAGNOSIS: Left spermatocele.
OPERATIONS PERFORMED:
1. Left spermatocelectomy.
2. Bilateral vasectomies.
SURGEON: John Doe, MD
ASSISTANT: None.
ANESTHESIA: General inhalational anesthesia.
FINDINGS: A 1 cm left spermatocele.
SPECIMENS: Left spermatocele and bilateral vas deferens segments.
ESTIMATED BLOOD LOSS: Minimal.
DRAINS: None.
COMPLICATIONS: None.
DISPOSITION: Stable.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old African-American male who desires a vasectomy. He has a symptomatic left spermatocele. He presents for left spermatocelectomy and bilateral vasectomies. Risks and benefits of the procedure, including bleeding, infection, damage to the testicles, loss of testicles, failure to diagnose and treat all disease, recurrence of disease, need for further procedures, were explained to the patient prior to the procedure, and he wished to proceed.
DESCRIPTION OF OPERATION: The patient was taken to the operating room, and after adequate anesthesia, he was placed in the supine position on the operating room table. The patient’s genitals were prepped and draped in a sterile fashion.
A 3 cm incision was made overlying the scrotal raphe. The left Dartos layer was then opened and the testicle was expressed within the tunica vaginalis from the left hemiscrotum. The tunica vaginalis was opened anteriorly, and a small amount of hydrocele fluid was evacuated. The testicle was visibly and palpably normal. There was a 1 cm spermatocele in the head of the epididymis. Using Bovie electrocautery, we detached this from the epididymis and from the head of the testicle without difficulty. We sent these to Pathology. We then reattached the epididymis to the superior pole of the testicle with interrupted chromic sutures. We then isolated, doubly ligated, and divided the vas deferens just above the testicle. We removed a 1 cm portion and fulgurated both ends. We buried the proximal end beneath the tunica vaginalis and kept the distal end above the tunica vaginalis. Both ends of the vas were also fulgurated. We then everted the tunica vaginalis upon itself and sewed it back upon itself with chromic suture. We then replaced them back within the left hemiscrotum. We then opened the scrotal septum and isolated, doubly ligated, and divided the right vas deferens approximately 3 cm above the right testicle. We removed a 1 cm portion and fulgurated both ends, tied off both ends with Vicryl suture, and buried the distal end beneath the tunica, keeping the proximal end above the tunica.
We then irrigated the wound and obtained excellent hemostasis. We then closed the Dartos layer with running locking chromic suture. We then closed the skin edges with interrupted chromic suture in horizontal mattress fashion. The wound was cleansed and a sterile fluff dressing and athletic supporter were placed. The sponge, needle, and instrument counts were correct following the procedure. There were no complications. He was instructed to continue birth control until negative semen analysis was obtained at eight weeks. He was transported to the postanesthesia care unit in stable condition.
