Chapter 8: Table of Contents
Knot and Transect
To use the multiple knot technique, transect the ductus close to the testis and gently separate the ductus from the vessels along its length. Next, create multiple, square knots between the ductus and the vessels. Appose each throw tightly to the previous one and ensure that you do not include the vaginal tunic or hair within your knots. Apply a minimum of two square knots (i.e. four throws). Inspect the knots and if satisfied, transect the remaining tissues a few millimeters distal to the last knot to remove the testis. Release the knotted spermatic cord within the vaginal tunic and replace the tissues within the scrotal incision. An alternative technique involves the creation of a single figure-of-eight knot using a hemostatic clamp. This technique is somewhat faster but must be mastered to prevent postoperative hemorrhage since it relies on a single knot. Repeat the procedure on the contralateral side, through a separate scrotal incision. The scrotal incisions are examined for bleeding or exteriorized tissues and then gently apposed with digital pressure and left to heal by second intention.