Orchiopexy for Left Undescended Testis (One year old boy) By Dr. Tamer Ashraf Wafa

Hello and welcome. This video shows an orchiopexy on the left side for a one year old boy. A lower abdominal crease, 2 centimeter incision is made. The superficial fascia and scorpbus fascia are opened using monopolar dithermy. The external oblique aponeurosis is exposed and open along its fibers. Extending downwards toward the external er ring. The chord structures are usually found at this position, gently grasped and dissected. The ileo inguinal nerve is seen and bluntly dissected. The cremasteric fascia and muscles are split bluntly, exposing the testes inside the internal spermatic fascia. The distal attachment of the thesis is gradually freed. Until the gubernaculum exposed and divided. Here you can see the initial length before dissection. Lengthening of the cord is distorted by dissection of the sac. Here a posterior approach is used. The edge of the sack is seen and gently grasped and dissected away from the core structures. The buds and vessels are carefully dissected off the sack. A window is created between the sack and bosom vessels. Now the sack is grasped by a hemostat and divided. An extra length of the cord structure is seen after a division of the sack. Now any connective tissue that is causing tittering of the cord structures is carefully divided. The core structures are further dissected of the fascia transversales up to the internal ring. The fascia transversalis forming the posterior wall of the inguinal canal is divided. This allows medialization of the chord structures. The inferior epigastric vessels can be encountered at this position. Now this is the length after medialization. Further retroperitoneal dissection is carried out. This provides extra length. For the court This is the final length which is adequate for the testes to reach the scrotum. The sack is twisted, transfixed and ligated. A 40 absorbable suture is used. A skin crease scrotal incision is made. Followed by the creation of a subdorsus pouch. A fine tipped hemostat it introduced through the dortus fascia. Under the subcutaneous fat up to the incision. Orientation of the test is made clear to avoid twist. Then the test is grasped carefully and gently exteriorized through a small puncture in the dorsus fascia. The core structures are checked to avoid any twist, then the test and its coverings. Are housed in the subdorsus pouch. The scrotal incision is closed with absorbable sutures. And then the angular incision is closed in layers. 3 or 40 sutures are usually used. The subcutaneous tissue is approximated with interrupted sutures, and the skin is closed with subcuticular sutures. Thank you for watching.