OT notes · Urology

Orchidectomy (high inguinal / simple)

Usual anaesthesia
Spinal or general (local / cord block possible for simple scrotal orchidectomy)
Position
Supine
Setting
elective

Operative note template for orchidectomy by the inguinal route (suspected cancer) or the scrotal route (benign causes and hormonal castration), with a filled example for a right high inguinal orchidectomy for a testicular mass.

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Blank template

Follow this order in the case sheet. Tick the options that apply and fill the blanks.

Patient and case

  1. Name / Age / Sex
  2. UHID / IP no. / Ward-Bed
  3. Date of surgery / OT no.
  4. CaseElectiveEmergency (non-elective)if emergency, state urgency and reason
  5. Timesin OT ___ anaesthesia start ___ incision ___ closure ___ out of OT ___

Team

  1. Operating surgeonname, designation
  2. Assistant(s)
  3. Supervising consultantpresent in OT / available / not applicable
  4. Steps done by the residentwhole procedure / named steps, under whose supervision
  5. Anaesthetist
  6. Scrub nurse / circulating nurse

Diagnosis and procedure

  1. Pre-operative diagnosis
  2. Post-operative diagnosis
  3. Procedure planned
  4. Procedure performedif different from plan, state why
  5. Extra procedure done and reason'none' if none. Only to save life or health if not consented

Consent and safety checks

  1. Informed consentGeneralProcedure-specificHigh-riskAnaesthesiain a language the patient understands: language ___ witness ___
  2. Site / side markedYesNot applicable
  3. WHO Surgical Safety ChecklistSign inTime outSign out
  4. Antibiotic prophylaxisdrug, dose, route, time given before incision
  5. VTE prophylaxisMechanicalPharmacologicalNot indicated

Risks to explain in the consent for this operation

  • scrotal haematoma and swelling
  • wound infection
  • injury to the ilioinguinal nerve with numbness of the groin (inguinal route)
  • loss of fertility and hormone effects if the other testis is poor or both are removed
  • change in appearance of the scrotum; option of a prosthesis
  • hot flushes, loss of libido and bone thinning after bilateral orchidectomy
  • further treatment (surveillance, chemotherapy, radiotherapy, RPLND) depending on the histology

Pre-operative details for this operation

  1. IndicationSuspected testicular tumourHormonal castration for prostate cancerNon-viable testis (torsion / trauma)Infection not settling on treatmentOther
  2. SideRightLeftBilateralside confirmed clinically and on USG, and marked
  3. Scrotal USG findingssize and nature of lesion; opposite testis normal or not
  4. Tumour markers before surgery (suspected tumour)AFP, beta-hCG, LDH with values and date
  5. Staging CTchest, abdomen, pelvis: done before surgery or planned
  6. Sperm banking offeredOffered: accepted / declinedNot applicable
  7. Testicular prosthesis discussedWants prosthesisDeclined

Anaesthesia and position

  1. AnaesthesiaSpinalGeneralLocal / spermatic cord blockSedation + local
  2. PositionSupine
  3. Field preparedlower abdomen, penis and scrotum painted and draped

Operative findings

  1. Testissize, mass: site, size, consistency; tunica intact or not
  2. Spermatic cordthickened / nodular / normal; any hernia sac
  3. Epididymisnormal / involved
  4. Scrotal skinNot involvedInvolved / previously violated (biopsy, scrotal incision)

Procedure (steps)

  1. ApproachInguinal (for suspected cancer)Scrotal midline rapheScrotal transverseSubinguinal
  2. Inguinal incisionabout 2 cm above and lateral to pubic tubercle, along skin crease, length 5 to 7 cm; extended onto scrotum if tumour is large
  3. External oblique opened, ilioinguinal nerve identified and protectedYes
  4. Early cord controlPenrose tourniquet or non-crushing clamp at internal ring before handling the testis
  5. Testis delivered into wound in its tunica vaginalisgubernaculum divided; tumour not breached
  6. High ligation of cord at internal ringvas and vessels ligated separately; suture material and size; long tails left on the stump
  7. Scrotal orchidectomy technique (benign / castration)Total (cord ligated in bundles)SubcapsularEpididymis-sparingsuture used for cord
  8. Haemostasiscord stump and scrotum checked; irrigation
  9. ProsthesisPlaced: make, size, fixationNot placed

Closure, drains and dressing

  1. External oblique aponeurosissuture, nerve not caught
  2. Scarpa fascia / dartossuture
  3. SkinSubcuticularInterruptedStaplessuture material and size
  4. Local anaesthetic infiltrationdrug, strength, volume
  5. DrainNoneScrotal drain (reason)
  6. Dressingfluff dressing and scrotal support

Specimens and implants

  1. Testis with cord for HPEside, cord length, stitch marking the cord end; in formalin with requisition
  2. Testicular prosthesismake, size, lot / serial number, sticker pasted

End of procedure

  1. Estimated blood lossml
  2. IV fluids and blood / products givenfluids (ml); blood: type, units, bag nos.
  3. Swab, needle and instrument countCorrectIncorrect: action taken
  4. Intra-operative complications / difficultieswhat happened and what was done; 'none' if none
  5. Implant stickersNo implantAffixed in case sheet, OT register and for discharge summary
  6. Condition at end of surgery / shifted toPACUWardICU/HDU

Post-operative orders

  1. Scrotal support and wound checklook for haematoma
  2. Analgesiadrug, dose, frequency
  3. Diet and mobilisationorals once spinal wears off; ambulate same day
  4. Dischargeday care or next day
  5. Tumour markers after surgeryAFP, beta-hCG, LDH repeated; date
  6. HPE and staging reviewOPD date; tumour board / oncology referral
  7. Stitch removal / wound reviewdate if non-absorbable

Signature

  1. Name and designation of person writing note
  2. Medical Council registration no.
  3. Signature / date / time of writingwrite before the patient leaves recovery

Worked example

Fictional case: Mr. A.R., 29 years, painless hard swelling of the right testis for 2 months; USG shows a 3 cm hypoechoic intratesticular mass, left testis normal.

Case details

Date: 03/08/2026. Elective right high inguinal orchidectomy. OT 1.

In OT 11:00. Spinal 11:08. Incision 11:20. Closure completed 12:05.

Surgeon: Dr A. (2nd-year resident, General Surgery / Urology). Assistant: Dr B. Consultant: Dr C., scrubbed.

Anaesthetist: Dr D. Scrub nurse: Sr E.

Indication and pre-op

Right testicular mass 3 x 2.5 cm on USG, hypoechoic, heterogeneous. Left testis normal.

Pre-op markers 30/07/2026: AFP 85 ng/ml, beta-hCG 12 mIU/ml, LDH 310 U/L. CT chest, abdomen and pelvis done 31/07/2026 (report in file).

Sperm banking offered and explained; patient declined in writing. Prosthesis offered; declined.

Consent: general, procedure-specific and anaesthesia consent taken in Hindi. Right side marked.

WHO checklist done. Inj cefazolin 2 g IV at 11:12, before incision.

Anaesthesia and position

Spinal anaesthesia. Supine. Lower abdomen, penis and scrotum painted with povidone-iodine and draped.

Procedure

Right inguinal skin-crease incision 6 cm, starting 2 cm above and lateral to the pubic tubercle. Camper and Scarpa fascia divided.

External oblique opened in line of its fibres up to the external ring. Ilioinguinal nerve identified, freed from the cord and retracted away.

Cord mobilised at the pubic tubercle without breaching the floor of the canal. Penrose drain passed twice round the cord at the internal ring and clamped as a tourniquet before handling the testis.

Findings: right testis enlarged with a hard mass in the lower pole, tunica intact. Cord normal, no hernia sac. Scrotal skin not involved.

Testis delivered into the wound within the tunica vaginalis by pushing up from the scrotum. Gubernaculum divided with cautery. Tumour not breached.

Cord skeletonised at the internal ring. Vas ligated and divided separately with silk 2-0. Cord vessels doubly ligated with silk 0 and divided at the internal ring. Long tails left on the stump. Specimen removed.

Scrotal cavity and inguinal floor checked: haemostasis secured. Wound irrigated with saline.

Closure

External oblique closed with continuous polyglactin 910 (Vicryl) 2-0, ilioinguinal nerve not caught.

Scarpa fascia closed with Vicryl 3-0. Skin closed with subcuticular poliglecaprone (Monocryl) 4-0.

Wound infiltrated with bupivacaine. No drain. Fluff dressing and scrotal support.

Specimens and implants

Right testis with spermatic cord (about 8 cm) sent for HPE in formalin. Cord end marked with a long silk stitch. Requisition includes pre-op marker values.

No implant.

End of procedure

Estimated blood loss 30 ml. No transfusion.

Mop, needle and instrument count correct.

No intra-operative complications.

Shifted to recovery. Pulse 76/min, BP 120/74 mmHg.

Post-op orders

Vitals 4-hourly. Watch for scrotal swelling.

Orals when spinal wears off. Ambulate in the evening.

Analgesia as per unit protocol.

Discharge on POD 1 with scrotal support.

Repeat AFP, beta-hCG and LDH after surgery (date written on the chart), and review with HPE report for staging and oncology referral.

Signature

Dr A., JR-2. Reg. no. ________. 03/08/2026, 12:20.

Must document for this operation

  • Route used (inguinal for suspected cancer) and that the scrotum was not opened. A scrotal approach to a testicular tumour changes the staging and later treatment, so the note must show the scrotum was left intact.
  • Level of cord ligation (at the internal ring) and the suture used, with long tails left on the stump. The surgeon doing a later retroperitoneal lymph node dissection (RPLND) looks for this stump.
  • Pre-operative tumour marker values (AFP, beta-hCG, LDH) with dates. Post-op markers are read against them for staging and for deciding further treatment.
  • Sperm banking offered, and the patient's decision. Fertility may be affected by the surgery and later treatment; this protects both patient and surgeon.
  • Tumour breached or not, and scrotal skin involvement. Spillage or skin involvement changes the treatment plan for the scrotum.
  • Prosthesis make, size and serial number, if placed. An implant must be traceable in case of recall or infection.

Common mistakes in these notes

  • Writing 'orchidectomy done' without the route and level of cord ligation.
  • Not recording the pre-op markers, so post-op values cannot be interpreted.
  • Not documenting that sperm banking and a prosthesis were offered.
  • Leaving out the side in the procedure line.
  • Sending the specimen without marking the cord end or giving the markers on the form.

Indian practice and paperwork

  • A testis sent for HPE goes in formalin with a requisition. Tissue not sent is human anatomical waste for the yellow bag, and discarded formalin is yellow (f) chemical waste. (Bio-Medical Waste Management Rules 2016, CPCB guidelines)
  • If a testicular prosthesis is placed, NABH asks that its batch and serial number be written in the patient's record, the OT master logbook and the discharge summary. (NABH 5th ed., MOM.10(d))

Sources

  • Smith JA Jr, Howards SS, Preminger GM, Dmochowski RR, eds. Hinman's Atlas of Urologic Surgery. 5th ed. Elsevier; 2026, Ch 109, Simple Orchiectomy (McIntosh, Stratton); Ch 117, Radical Orchiectomy (Hall), pp. 875-877, 916-918.
  • Smith JA Jr, Howards SS, Preminger GM, eds. Glenn's Urologic Surgery. 8th ed. Wolters Kluwer; 2016, Ch 58, Simple Orchiectomy; Ch 59, Radical Inguinal Orchiectomy (Lee, Scherr), e-book PDF pp. 870-887.
  • Bratzler DW, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283. Table 1: cefazolin 2 g IV adult (3 g if 120 kg or more), within 60 min before incision. Table 2, urologic, clean without entry into urinary tract: cefazolin. academic.oup.com/ajhp/article/70/3/195/5112717

Educational template for residents. Adapt it to your institution's case-sheet format and your consultant's instructions. Patient details in the example are fictional.

Videos of this operation

Teaching videos and pages for this operation, listed under the curriculum item that asks for it.

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