Minimally Invasive No Touch Technique for Subinguinal Orchiectomy and Testicular Prosthesis Insertion

Abstract

Introduction:

Minimally invasive no touch (MINT) technique approach aims to minimize infection and features the use of wound retractors and drapes to all but eliminate exposure to skin flora; it is done as part of a comprehensive perioperative anti-infection protocol, allowing the surgeon to completely insert a prosthesis in a patient without touching the skin. In addition, there is a theoretical advantage of protecting the wound edges from tumor cell implantation. ¹ This technique was popularized in urology for use in the insertion of penile implants and has been shown to be effective in decreasing rate of infection to <1%. ² The rate of infection after testicular prosthesis insertion is not well commented on within the literature but generally reported as <1.5%. ^3,4 When infection does occur, it is associated with a high morbidity with most cases requiring removal of the implant. This is associated with significant cost to the health care system.

Methods:

Each key step is demonstrated. After a wet shave and preparation, the first layer of MINT drapes is applied. A 3–4 cm subinguinal incision is made and the Alexis^® retractor is placed. The approximate cost of the Alexis retractor is $75 USD per piece. Once the Alexis is in place, this completes the setup for the MINT technique as skin is completely protected from the surgical field. Gubernaculum can be divided with easy readjustment and testis is removed. Gloves are then changed and prosthesis is prepared. The prosthesis is positioned through two anchoring sutures, helpfully the scrotal skin can be everted/repositioned smoothly through the retractor while the implant is secured. Wound closure is performed with a layered technique, the Alexis retractor can be used to assist with the deep layer closure before being removed.

Results:

This single patient video is taken from a small series (N = 4) of patients in whom this easily reproducible technique was utilized. The underlying diagnosis for testicular removal before prosthesis insertion for all patients was testis tumor. There have been no patient complications reported after median follow-up of 12 months.

Conclusion:

After viewing this video, the surgeon will understand each key step needed to perform the MINT technique with subinguinal orchiectomy and testicular prosthesis placement.

No competing financial interests exist

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Runtime of video: 4 mins 48 secs