- Email: [email protected]
Videos
Live Demonstration/Videos
Chapter 4.1 The basic skills of scrotoscope The skin incision (0.5 1.0 cm in length) is made on the scrotum wall. Then the surgeon and the assistant each use a mosquito clamp to raise the sarcolemma. The sarcolemma is opened by the surgeon using tissue scissors. The parietal layer of the tunica vaginalis is opened to reach the cavity of the tunica vaginalis. Place the scrotoscope and perform the examination of tunica vaginalis cavity, testis, and epididymis. Chapter 4.2 Scrotal supporter dressing The scrotal supporter dressing comprises two pieces of bandages to the four angles of a large cotton pad. The supporter functions like a hammock that holds the scrotum and its contents together. Chapter 6.1 The examination and biopsy under scrotoscope Following a 1-cm anterior scrotal incision on the ill side, the tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. The scrotoscope is passed through the incision with continuous infusion of isotonic crystalloid solution. The scrotal contents including the testis, epididymis, and spermatic cord are examined. Various types of pathological demonstration can be observed under the endoscopic view. If necessary, biopsy is performed. Chapter 6.2 The management of testicular torsion under scrotoscope Following a 1-cm anterior scrotal incision on the ill side, the tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. The scrotoscope is passed through the incision. Typical presentations of testicular torsion under the scrotoscope include significant edema of the testicle accompanied by ischemic changes, such as significant erythema and ecchymosis presentation. Following clinical decision is made according to the scrotoscopic views. Chapter 6.3 The management of closed scrotal trauma under scrotoscope Following a 1-cm anterior scrotal incision on the ill side, the tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. The scrotoscope is passed through the incision. Then the surgeon can observe the testicle and parietal layer of the tunica vaginalis. The normal testicle should be white in color, with a smooth surface and no swelling. In the case of testicular rupture, there could be a wound on the testicular tunica albuginea. Seminiferous tubules come out from the wound and have a yellow, brain-like appearance, with or without bleeding. The surgeon should continue to explore the cavity of the perididymis in a clockwise fashion. If exploratory scrotoscopy reveals a testicular rupture, primary repair should be performed. Chapter 6.4 The drainage of epididymal abscess under scrotoscope Following a 1-cm anterior scrotal incision on the ill side, the tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. The scrotoscope is passed through the incision. Thoroughly examine scrotal contents under the scrotoscope. Some pustular lesions are located on the surface of the testis and epididymis, and some even form adhesions. Further observation is made of the epididymis. Pus is punctured under the scrotoscope and needle aspiration of pus is made to confirm the scrotoscopic observations. Pus is checked for bacterial culturing and the drug sensitivity test. Chapter 6.5 The management of old hematoma of tunica vaginalis under scrotoscope Following a 1-cm anterior scrotal incision on the ill side, the tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. The scrotoscope is passed through the incision. Thoroughly examine scrotal contents under the scrotoscope. Under scrotoscopy, a great number of old brownish black clots can be found in the tunica vaginalis sac. The inner surface of the parietal layer of the tunica vaginalis loses its normal appearance and becomes rough. The surface of the testicle can be covered by rufous fibrosis gores. Biopsy of suspicious lesions can be performed. Chapter 6.6 The management of pyocele under scrotoscope Before making the incision, the surgeon uses a 10-mL syringe to pierce the cavity of the tunica vaginalis, draws out a yellow turbidity liquid, and performs a bacterial culture examination. Following a 1-cm anterior scrotal incision, the tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. The scrotoscope is passed through the incision. When the cavity of the tunica vaginalis is open, a large amount of yellow turbidity purulent liquid is visible. The surgeon uses one hand to gently knead the scrotum to make the pus out, while his other hand takes a 50-mL syringe to pump complexing iodine and flush the cavity of the tunica vaginalis three times. Scrotoscopic examination is made. In order to diagnose epididymal abscess, the diagnostic puncture of the epididymis should be performed.
xiii
xiv
LIVE DEMONSTRATION/VIDEOS
Chapter 7.1 Scrotoscope-assisted testicular biopsy Following a 1-cm anterior scrotal incision, the tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. The scrotoscope is passed through the incision. Scrotoscopic examination is then made. The appearance and anatomical relationship of the spermatic cord, epididymis, and testicle is examined and biopsy of suspicious lesions is made. Chapter 7.2 Scrotoscope-assisted vaginectomy Following a 1-cm anterior scrotal incision, the tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. A slightly yellow transparent liquid would overflow. The scrotoscope is passed through the incision. Scrotoscopic examination is then made. The appearance and anatomical relationship of the spermatic cord, epididymis, and testicle is observed. Withdraw the scrotoscope and perform vaginectomy. Put the index finger of the left hand into the cavity of the perididymis and pull the parietal layer of the tunica vaginalis out of the scrotum. Use electrotome to cut off the isolated tunica vaginalis and bleeding of any wound edge should be coagulated. Then perform scrotoscopy again. Chapter 7.3 Scrotoscope-assisted surgery of spermatic hydrocele Locate the spermatic cord hydrocele and open it from the anterior wall. Separate the tissue, use two Allis clamps to nip the full wall layer when opening the parietal layer tunica vaginalis, so the work space is created and we can observe the cavity of the spermatic vaginalis and the contents with scrotoscope. Then withdraw the scrotoscope and perform hydrocelectomy of the spermatic cord through the notch. Chapter 7.4 Scrotoscope-assisted excision of intra-scrotal mass excision with mini-incision Make an incision nearly 1 cm in length in scrotal skin, separate the tissue, and insert the scrotoscope into the tunica sac with continuous saline irrigation. Observe scrotal contents under the scrotoscope to find out mass. Excision would be applied if the mass location is proper for resection under the scrotoscope, but if the mass is on special anatomical positions, it would be dragged out of the incision to be removed. Separate the mass from the surrounding tissues and then excise it. Take care of the vas deferens during surgery. Insert the scrotoscope following the former incision to verity that the mass has been completely removed, and no bleeding or surgical accidental injuries have occurred to other tissues. Chapter 7.5 Scrotoscope-assisted excision of scrotal wall masses Make an incision nearly 1 cm in length in scrotal skin, separate the tissue, and insert the scrotoscope into the tunica sac with continuous saline irrigation. Observe scrotal contents under the scrotoscope and determine the origin of the mass during this process. Withdraw the scrotoscope and fix the mass. Make a scrotal incision just above the mass, then separate and extrude the mass to the incision. Isolate and remove the mass at a distance of about 2 3 cm to the normal tissues. Insert the scrotoscope again to observe whether the mass has been completely removed, and whether there are bleeding sites or accidental surgical injuries. Chapter 8.1 Scrotoscopic excision of epididymal cysts Confirm the location and size of cysts, establish a small incision, fix the affected side of the testis and epididymis together, and make a 1-cm incision in the anterior wall of the scrotum. Separate the tissue layer by layer to the tunica vaginalis cavity and clamp the whole wall of the scrotum with two Allis clamps. Insert the scrotoscope, observe the contents of the scrotum, and clear the cyst position. The epididymal cyst is under vision and located in the head of the epididymis. Then unroof the cyst so that the edge of the cyst wound should be completely coagulated to reduce the cyst recurrence. Finally, endoscopic observation should be done again, to observe if the edge of the cyst wound bleeds, and pay attention to whether torsion or injury of the epididymis or testicle occurs. Chapter 8.2 Scrotoscopic excision of scrotal wall cysts Clear the cyst location, size, number, and other characteristics, and then establish a small incision and make a 1-cm incision in the anterior wall of the scrotum. Separate the tissue layer by layer to the tunica vaginalis cavity and clamp the whole wall of the scrotum with two Allis clamps. Insert the scrotoscope, observe the contents of the scrotum, and clear the cyst position. The presenting cysts are located in the back of the epididymis and testis, and cyst resection begins first from the central cyst. The specific procedure of cyst resection starts from the weakest wall of a cyst and the sheath of the tunica vaginalis is cut off. And then remove part of the cyst wall, put the electric loop into the cyst cavity, keep the scrotoscopy immovability, and drag the electric loop slowly backward, and then remove the cyst wall subsequently. If necessary, withdraw the scrotoscope and make clear whether there are residual cysts. When residual cysts do exist, we emphasize using the lifting technology by the left hand and lifting the cysts into the cavity of the tunica vaginalis and reput the scrotoscope into the scrotum; otherwise, these cysts may miss. The cyst head would be removed finally. It should be noted that the sperm cord and other important structures cannot be damaged intraoperatively. If not, you may even cut through the scrotum skin. Both observation and resection must be performed simultaneously under direct vision. Finally, endoscopic observation should be done again, to observe whether bleeding occurs or not, whether injury or torsion of the spermatic cord, or injury of the epididymis or testis happens, and whether residual cyst is left. Chapter 8.3 Scrotoscopic excision of epididymal (caput) masses Make a 5 8 mm longitudinal incision at the lower position in the front wall of the scrotum. Separate the tissue layer by layer to expose the testis. Make a pathway for the scope sheath to enter the tunica sac with continuous saline irrigation, observe the inner wall of the scrotum, testis, spermatic cord, and epididymis to distinguish the epididymal masses. Install the electrode loop, extend the electrode loop to the rear of the mass, and then pull it back to cut the lump into pieces gradually. Use the electrode loop to push away the resected tissues. After excision of the lump, carefully observe the internal structure of the scrotum and confirm that the lump has been completely resected without obvious bleeding and other structures have no damage.
LIVE DEMONSTRATION/VIDEOS
xv
Chapter 8.4 Scrotoscopic epididymectomy Make a 1-cm anterior scrotal incision on the ill side, separate the tissues, and make a pathway for the scope sheath to enter the tunica sac and clamp the whole wall of the scrotum with two Allis clamps. Insert the scrotoscope and observe the contents of the scrotum sequentially. Confirm the epididymal lesion and resect the entire epididymis in a systematic fashion. The resection can begin by taking down the epididymis from the head to tail and deeply reach the plane between the epididymis and testicle. Reperform the scrotoscopy and inspect the resection site for hemostasis. Chapter 8.5 Scrotoscopic excision of epididymal (cauda) masses Set a resectoscope device as a scrotoscope and make a 1-cm anterior scrotal incision on the ill side. The tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. Insert the scrotoscope, observe the contents of the scrotum sequentially, and confirm intra-scrotal lesions. At the presence of an epididymal tail mass, it can be resected in a systematic fashion. After determining the mass, the parietal layer of the tunica vaginalis covering the tail is resected. Reperform a scrotoscopy and inspect the resection site for hemostasis. The scrotal incision is then closed with one stitch. The drainage strip is routinely removed after 24 hours. Chapter 8.6 Scrotoscopic subcapsular orchiectomy Make a 1-cm incision through the skin, dartos, and tunica vaginalis in the anterior inferior wall of the scrotum, to make a passageway for scrotoscopy. Insert a F22 adult cystoscope and observe the contents of the scrotum. Incise the tunica albuginea under direct vision for an incision of 1 cm, expose the contents of the testis, and place four to five tissue forceps to clamp the full-thickness skin and tunica albuginea. Erase the parenchyma testis under direct vision and pull the testicle out of the tunica albuginea cavity with Allis forceps. Wipe out the parenchyma testis adhering to the tunica albuginea with a bone curette. Maintain a firm grip on the skin and wound of the tunica albuginea with Allis forceps. Make sure that there is no bleeding. Place two rubber membrane drainages in the cavity of the tunica vaginalis and tunica albuginea, respectively. Suture the skin, the dartos layer, and the parietal layer of the tunica vaginalis with a 4 0 absorbable ligature.
Chapter 4.1 The basic skills of scrotoscope The skin incision (0.5 1.0 cm in length) is made on the scrotum wall. Then the surgeon and the assistant each use a mosquito clamp to raise the sarcolemma. The sarcolemma is opened by the surgeon using tissue scissors. The parietal layer of the tunica vaginalis is opened to reach the cavity of the tunica vaginalis. Place the scrotoscope and perform the examination of tunica vaginalis cavity, testis, and epididymis. Chapter 4.2 Scrotal supporter dressing The scrotal supporter dressing comprises two pieces of bandages to the four angles of a large cotton pad. The supporter functions like a hammock that holds the scrotum and its contents together. Chapter 6.1 The examination and biopsy under scrotoscope Following a 1-cm anterior scrotal incision on the ill side, the tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. The scrotoscope is passed through the incision with continuous infusion of isotonic crystalloid solution. The scrotal contents including the testis, epididymis, and spermatic cord are examined. Various types of pathological demonstration can be observed under the endoscopic view. If necessary, biopsy is performed. Chapter 6.2 The management of testicular torsion under scrotoscope Following a 1-cm anterior scrotal incision on the ill side, the tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. The scrotoscope is passed through the incision. Typical presentations of testicular torsion under the scrotoscope include significant edema of the testicle accompanied by ischemic changes, such as significant erythema and ecchymosis presentation. Following clinical decision is made according to the scrotoscopic views. Chapter 6.3 The management of closed scrotal trauma under scrotoscope Following a 1-cm anterior scrotal incision on the ill side, the tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. The scrotoscope is passed through the incision. Then the surgeon can observe the testicle and parietal layer of the tunica vaginalis. The normal testicle should be white in color, with a smooth surface and no swelling. In the case of testicular rupture, there could be a wound on the testicular tunica albuginea. Seminiferous tubules come out from the wound and have a yellow, brain-like appearance, with or without bleeding. The surgeon should continue to explore the cavity of the perididymis in a clockwise fashion. If exploratory scrotoscopy reveals a testicular rupture, primary repair should be performed. Chapter 6.4 The drainage of epididymal abscess under scrotoscope Following a 1-cm anterior scrotal incision on the ill side, the tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. The scrotoscope is passed through the incision. Thoroughly examine scrotal contents under the scrotoscope. Some pustular lesions are located on the surface of the testis and epididymis, and some even form adhesions. Further observation is made of the epididymis. Pus is punctured under the scrotoscope and needle aspiration of pus is made to confirm the scrotoscopic observations. Pus is checked for bacterial culturing and the drug sensitivity test. Chapter 6.5 The management of old hematoma of tunica vaginalis under scrotoscope Following a 1-cm anterior scrotal incision on the ill side, the tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. The scrotoscope is passed through the incision. Thoroughly examine scrotal contents under the scrotoscope. Under scrotoscopy, a great number of old brownish black clots can be found in the tunica vaginalis sac. The inner surface of the parietal layer of the tunica vaginalis loses its normal appearance and becomes rough. The surface of the testicle can be covered by rufous fibrosis gores. Biopsy of suspicious lesions can be performed. Chapter 6.6 The management of pyocele under scrotoscope Before making the incision, the surgeon uses a 10-mL syringe to pierce the cavity of the tunica vaginalis, draws out a yellow turbidity liquid, and performs a bacterial culture examination. Following a 1-cm anterior scrotal incision, the tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. The scrotoscope is passed through the incision. When the cavity of the tunica vaginalis is open, a large amount of yellow turbidity purulent liquid is visible. The surgeon uses one hand to gently knead the scrotum to make the pus out, while his other hand takes a 50-mL syringe to pump complexing iodine and flush the cavity of the tunica vaginalis three times. Scrotoscopic examination is made. In order to diagnose epididymal abscess, the diagnostic puncture of the epididymis should be performed.
xiii
xiv
LIVE DEMONSTRATION/VIDEOS
Chapter 7.1 Scrotoscope-assisted testicular biopsy Following a 1-cm anterior scrotal incision, the tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. The scrotoscope is passed through the incision. Scrotoscopic examination is then made. The appearance and anatomical relationship of the spermatic cord, epididymis, and testicle is examined and biopsy of suspicious lesions is made. Chapter 7.2 Scrotoscope-assisted vaginectomy Following a 1-cm anterior scrotal incision, the tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. A slightly yellow transparent liquid would overflow. The scrotoscope is passed through the incision. Scrotoscopic examination is then made. The appearance and anatomical relationship of the spermatic cord, epididymis, and testicle is observed. Withdraw the scrotoscope and perform vaginectomy. Put the index finger of the left hand into the cavity of the perididymis and pull the parietal layer of the tunica vaginalis out of the scrotum. Use electrotome to cut off the isolated tunica vaginalis and bleeding of any wound edge should be coagulated. Then perform scrotoscopy again. Chapter 7.3 Scrotoscope-assisted surgery of spermatic hydrocele Locate the spermatic cord hydrocele and open it from the anterior wall. Separate the tissue, use two Allis clamps to nip the full wall layer when opening the parietal layer tunica vaginalis, so the work space is created and we can observe the cavity of the spermatic vaginalis and the contents with scrotoscope. Then withdraw the scrotoscope and perform hydrocelectomy of the spermatic cord through the notch. Chapter 7.4 Scrotoscope-assisted excision of intra-scrotal mass excision with mini-incision Make an incision nearly 1 cm in length in scrotal skin, separate the tissue, and insert the scrotoscope into the tunica sac with continuous saline irrigation. Observe scrotal contents under the scrotoscope to find out mass. Excision would be applied if the mass location is proper for resection under the scrotoscope, but if the mass is on special anatomical positions, it would be dragged out of the incision to be removed. Separate the mass from the surrounding tissues and then excise it. Take care of the vas deferens during surgery. Insert the scrotoscope following the former incision to verity that the mass has been completely removed, and no bleeding or surgical accidental injuries have occurred to other tissues. Chapter 7.5 Scrotoscope-assisted excision of scrotal wall masses Make an incision nearly 1 cm in length in scrotal skin, separate the tissue, and insert the scrotoscope into the tunica sac with continuous saline irrigation. Observe scrotal contents under the scrotoscope and determine the origin of the mass during this process. Withdraw the scrotoscope and fix the mass. Make a scrotal incision just above the mass, then separate and extrude the mass to the incision. Isolate and remove the mass at a distance of about 2 3 cm to the normal tissues. Insert the scrotoscope again to observe whether the mass has been completely removed, and whether there are bleeding sites or accidental surgical injuries. Chapter 8.1 Scrotoscopic excision of epididymal cysts Confirm the location and size of cysts, establish a small incision, fix the affected side of the testis and epididymis together, and make a 1-cm incision in the anterior wall of the scrotum. Separate the tissue layer by layer to the tunica vaginalis cavity and clamp the whole wall of the scrotum with two Allis clamps. Insert the scrotoscope, observe the contents of the scrotum, and clear the cyst position. The epididymal cyst is under vision and located in the head of the epididymis. Then unroof the cyst so that the edge of the cyst wound should be completely coagulated to reduce the cyst recurrence. Finally, endoscopic observation should be done again, to observe if the edge of the cyst wound bleeds, and pay attention to whether torsion or injury of the epididymis or testicle occurs. Chapter 8.2 Scrotoscopic excision of scrotal wall cysts Clear the cyst location, size, number, and other characteristics, and then establish a small incision and make a 1-cm incision in the anterior wall of the scrotum. Separate the tissue layer by layer to the tunica vaginalis cavity and clamp the whole wall of the scrotum with two Allis clamps. Insert the scrotoscope, observe the contents of the scrotum, and clear the cyst position. The presenting cysts are located in the back of the epididymis and testis, and cyst resection begins first from the central cyst. The specific procedure of cyst resection starts from the weakest wall of a cyst and the sheath of the tunica vaginalis is cut off. And then remove part of the cyst wall, put the electric loop into the cyst cavity, keep the scrotoscopy immovability, and drag the electric loop slowly backward, and then remove the cyst wall subsequently. If necessary, withdraw the scrotoscope and make clear whether there are residual cysts. When residual cysts do exist, we emphasize using the lifting technology by the left hand and lifting the cysts into the cavity of the tunica vaginalis and reput the scrotoscope into the scrotum; otherwise, these cysts may miss. The cyst head would be removed finally. It should be noted that the sperm cord and other important structures cannot be damaged intraoperatively. If not, you may even cut through the scrotum skin. Both observation and resection must be performed simultaneously under direct vision. Finally, endoscopic observation should be done again, to observe whether bleeding occurs or not, whether injury or torsion of the spermatic cord, or injury of the epididymis or testis happens, and whether residual cyst is left. Chapter 8.3 Scrotoscopic excision of epididymal (caput) masses Make a 5 8 mm longitudinal incision at the lower position in the front wall of the scrotum. Separate the tissue layer by layer to expose the testis. Make a pathway for the scope sheath to enter the tunica sac with continuous saline irrigation, observe the inner wall of the scrotum, testis, spermatic cord, and epididymis to distinguish the epididymal masses. Install the electrode loop, extend the electrode loop to the rear of the mass, and then pull it back to cut the lump into pieces gradually. Use the electrode loop to push away the resected tissues. After excision of the lump, carefully observe the internal structure of the scrotum and confirm that the lump has been completely resected without obvious bleeding and other structures have no damage.
LIVE DEMONSTRATION/VIDEOS
xv
Chapter 8.4 Scrotoscopic epididymectomy Make a 1-cm anterior scrotal incision on the ill side, separate the tissues, and make a pathway for the scope sheath to enter the tunica sac and clamp the whole wall of the scrotum with two Allis clamps. Insert the scrotoscope and observe the contents of the scrotum sequentially. Confirm the epididymal lesion and resect the entire epididymis in a systematic fashion. The resection can begin by taking down the epididymis from the head to tail and deeply reach the plane between the epididymis and testicle. Reperform the scrotoscopy and inspect the resection site for hemostasis. Chapter 8.5 Scrotoscopic excision of epididymal (cauda) masses Set a resectoscope device as a scrotoscope and make a 1-cm anterior scrotal incision on the ill side. The tunica sac is opened with a pair of Allis clamps holding the full scrotal layers. Insert the scrotoscope, observe the contents of the scrotum sequentially, and confirm intra-scrotal lesions. At the presence of an epididymal tail mass, it can be resected in a systematic fashion. After determining the mass, the parietal layer of the tunica vaginalis covering the tail is resected. Reperform a scrotoscopy and inspect the resection site for hemostasis. The scrotal incision is then closed with one stitch. The drainage strip is routinely removed after 24 hours. Chapter 8.6 Scrotoscopic subcapsular orchiectomy Make a 1-cm incision through the skin, dartos, and tunica vaginalis in the anterior inferior wall of the scrotum, to make a passageway for scrotoscopy. Insert a F22 adult cystoscope and observe the contents of the scrotum. Incise the tunica albuginea under direct vision for an incision of 1 cm, expose the contents of the testis, and place four to five tissue forceps to clamp the full-thickness skin and tunica albuginea. Erase the parenchyma testis under direct vision and pull the testicle out of the tunica albuginea cavity with Allis forceps. Wipe out the parenchyma testis adhering to the tunica albuginea with a bone curette. Maintain a firm grip on the skin and wound of the tunica albuginea with Allis forceps. Make sure that there is no bleeding. Place two rubber membrane drainages in the cavity of the tunica vaginalis and tunica albuginea, respectively. Suture the skin, the dartos layer, and the parietal layer of the tunica vaginalis with a 4 0 absorbable ligature.