Testicular Cancer – Surgery Day, Left Orchiectomy

Testicular Cancer Statistics

The Week Leading Up To Surgery

This week I was miserable. My mind would wander off in so many different directions and it made me sleepless and completely miserable until surgery day. When I did find peace, I found it through God. I was able to get the strength and tell myself it will be okay no matter what the outcome was.

This was also my first surgery. I had never been put to sleep before so I didn’t really know what to expect. Before my surgery I was told not to eat or drink anything for like 12 hours before surgery. I stopped eating and drinking at about 7PM the night before which was a mistake. My surgery was at 1PM the next day. I would have drank a lot more water leading up at when I had to stop if I could have redone that. When I showed up to the hospital I was really dehydrated.

Pre-Op Checkup and Blood Tests

The week leading up to my surgery day I had to go in and get a bunch of blood work done and a checkup. They drew the blood for tumor markers and checked me out to make sure I’d be ok for the general anesthesia. Everything pretty much checked out ok on this day. I arrived at the hospital and grabbed my TGIF looking beeper to get called in for my tests. Everything seemed to go well on this day.

Surgery Day

My wife drove me up to the hospital this day. I checked in and waited patiently to be brought back. After about 15 minutes of waiting, a nice lady came over and asked if I was Joe Zepernick and kindly took my away to my room. I gave my wife a kiss goodbye and started my dreadful walk back to where I’d be for a few hours.

She gave me a bag for all of my items and said I could watch tv and wished me luck. I quickly changed into the hospital gown and covered myself with a blanket. I pretty much laid there for awhile starring at the clock watching each minute tick by closer to my surgery time.

After some time in there, a nurse finally came in and administered my IV. This kind of felt good because it was hydrating me. When the time came a little closer to surgery time my room got a lot more active. I met with my anesthesiologist, a couple nurses and my doctor.

My doctor was a little late, but all was good. He came in, threw his car keys on the computer desk, then asked if I had actually seen the imaging. I told him I hadn’t seen any of the images yet. He logged into the computer and showed me the imaging of my left testicle.

When looking at the images from the ultrasound you could clearly see there was something wrong. He showed me the differences in appearance between my left and right one. You could clearly see a lot of shadowing and it general, it just didn’t look healthy.

He said he’d most likely be removing it that day. After he showed me the images he got up and left. One nurse who I think was the assistant to the anesthesiologist came in and said she was about to administer something to relax me. In her way of putting it I’d feel like I just consumed a 6 pack quickly.

After she gave that to me it took a minute but I was indeed very relaxed. They wheeled my into the OR which is when things got kind of fuzzy. I just remember transferring over to another table then I think somebody asked me some question which I thought I answered then it was lights out.

I was starting to wake up when they were wheeling me back to a recovery room. I joked a little about the Cavs then sat in a reclining chair. I really started to feel the pain when I sat up or tried to walk. I sat in the chair for a bit and had a little bit of water and a couple of crackers.

I just wanted to go home at this point. The nurse told me I wouldn’t be allowed to go home until I was able to pee there first. She hooked another bag up to me and gave me more water to speed that process up. I was finally able to pee! Yay! This was all a good sign. She gave me a pain med before I left and we were on our way.

I was a little out of it after the surgery but was still able to get around with some help. Two guys wheeled me out to my car where my wife picked me up out front. I was still kind of functional that day after. We went and picked up my meds and I was also able to see my daughter’s graduation ceremony at our Church!

It actually felt good to have that testicle out of me. I no longer had the aches associated with testicular cancer. I traded in the achy pain I was having for surgical pain which wasn’t horrible but was uncomfortable.

During the next week I was waiting on my pathology. During this whole process I did a whole lot of waiting. If you are going through something similar know that you’re probably going to be faced with the same. You will have to wait but just be sure you don’t drive yourself too crazy waiting for the results. There are things you can do which will take your mind off of it for awhile. Don’t let it control you. Check out my operation report below. It was actually kind of cool. Also, be sure to check out my pathology report on my next post.

There were some things that were concerning on my pathology. If you’re going through this experience as well be sure to proceed with caution during the next phase. It is critical you make sure the pathology is correct before making a decision on treatment options.

The OR Report

ANESTHESIA: General.

1ST Assistant:

PREOP DIAGNOSIS: Left testicular mass.
POSTOP DIAGNOSIS: Left testicular mass.
OPERATION: Left inguinal exploration and left radical orchiectomy.

SURGICAL INDICATIONS: Patient is a 33-year old health male whose brother was recently diagnosed with metastatic testicular cancer. He was experiencing some pain in the left testicle., which he felt could be psychological, but he went to his family practice doctor to get it checked out and was found to have a small mass in the inferior poll of the left scrotum and had a testicular ultrasound performed which revealed 3 hypoechoic lesions within the left testicle, suspicious for neoplasm. On physical exam, we cannot discern discrete nodule in the testicle, so we gave him 2 weeks of antibiotics, repeated the ultrasound, and again these 3 lesions within the testicle were unchanged in size or appearance from the previous ultrasound and after discussion of the options with him, he has opted for left radical orchiectomy. Risks, benefits, and alternative of therapies were reviewed with the patient. Consent obtained. Tumor markers normal.

OPERATIVE REPORT: The patient was brought to the operating room, put to sleep by Anesthesia. He was positioned supine on the operating room table, and the pelvis was shaved, prepped and draped in usual sterile fashion. External ring was palpated through the scrotum and a transverse incision was marked with a sterile marking pen just above the level of the external ring. With the patient asleep, we made a transverse incision just above the inguinal ring roughly 1.5 inches in length with a #15 scalpel blade. The subcuticular layers were divided with the Bovie.

There was a small vessel within the subcutaneous tissue layer, which was divided with a 3-1 Vicryl, and then the external oblique aponeurosis and fascia was exposed and the external ring was easily indentified. Weitlaner retractor was placed to expose the external ring, and then we freed up the spermatic cord laterally and medially, and we lifted the spermatic cord up through the incision and placed a tourniquet for hemostasis and to control and hematogenous seeding.

We then freed up the lateral medial cremasteric attachments to the cord, and we were able to deliver the testicle easily up through the incision. The testicle appear hypoplastic and soft and in the lower pole of the testicle was a firm nodule corresponding to the largest lesion seen on the ultrasound. For that reason, we opted to proceed with orchiectomy.

We divided the gubernacular attachments to the testicle with a Bovie, made a careful check for hemostasis and then we lifted up on the spermatic cord and dissected it back to the external ring, taking down any cremasteric attachments. We place a right angle clamp to the external ring and we lifted up on the external oblique aponeurosis and made a small incision along the line of the fibers with a 15 blade and took care not to injure the nerve.

We then exposed the cord, but not below the external oblique and then we divided the fatty later away from the cord which left just the spermatic cord contents itself. We doubly ligated this with Kelly clams and then we doubly ligated the fat alongside the cord and then we triply ligated the spermatic cord with 2-0 chromic ties and 1-0 chromic ligature. We then transected the cord on a sterile field to make sure there was no hematogenous seeding in the incision, and we sent the specimen for pathology inspection.

We then took off each of hte Kelly clamps, made a careful visual inspection of the cord, saw no evidence of any bleeding. So, we turned the stump of the cord back underneath the external oblique and then we reapproximated external oblique with interrupted sutures of 3-0 Vicryl.

We then made a careful check for hemostasis, saw no evidence of any active bleeding, so the Scarpa fascia was reapproximated with interrupted 3-0 chromic sutures and the skin was reapproximated with a 4-0 Vicryl subcuticular closure and we did place a 0.25% Marcaine in a subcuticular layer for local anasthetic, a total of 5mL was used. Sponge and needle counts were correct X2. Pathology is pending on specimens.

See my pathology report

To your life and health!