Chapter 8: Table of Contents
Clamp, Ligate and Transect
Apply three Carmalt clamps across these structures. Using absorbable suture material, apply a circumferential ligature within the crush of the most proximal clamp (closest to the patient- C1). Then, apply another circumferential or a transfixing suture between the first suture and the next clamp (C2), just a few millimeters from the first ligature. Assess the ligatures (ensuring not to occlude the vascular plexus with your clamp or forceps), and if satisfied, transect the spermatic cord between the two remaining clamps. Then remove the clamp attached to the stump and carefully assess for hemorrhage before replacing the stump within the vaginal tunic.
Repeat the process with the contra-lateral testis. As you mobilize the second testis cranially, you will need to make a second incision in the subcutaneous tissues and spermatic fascia in order to exteriorize the contralateral testis.If you do not open the vaginal tunic, you will perform a closed castration… in this instance, you should apply at least one transfixing suture to prevent slippage and retraction of the ductus deferens, testicular arteries or venous pampiniform plexus from the ligatures.