Bidirectional knotless barbed versus conventional smooth suture for closure of surgical wounds in inguinal castration in horses.

BACKGROUND: Castration of the stallion is one of the most frequently performed surgical procedures in the horse. Recently barbed suture materials for surgical wound closure were introduced to the market with manufacturers claiming that these sutures enhance speed and security as they eliminate the need to tie knots. Recently, it has been suggested that this type of suture may increase postoperative complications. This study aimed at investigating and comparing a bidirectional absorbable knotless barbed suture (KBS) to a conventional smooth suture (SS) for wound closure of inguinal castrations in the horse. This was done by evaluating short-term and post-discharge complications and by comparing the time spent on suturing the surgical wounds after bilateral inguinal castration, which was performed on 45 horses undergoing castration at The Large Animal Teaching Hospital at University of Copenhagen from September 2017 to May 2019. RESULTS: Short-term complications were few; at 24 h minor swelling occurred in 29 and 33% of horses sutured with KBS and SS respectively and cutaneous dehiscence during recovery occurred in two horses of each group. Post-discharge follow-up revealed that three horses needed veterinary attention for treatment of complications (scrotal swelling (n = 1, KBS); wound exudation (n = 1, SS) and wound dehiscence after return to pasture (n = 1, SS)). Wound closure was achieved 6 min faster with KBS than with SS (P < 0.0001). CONCLUSIONS: Use of the KBS suture did not result in increased occurrence of postoperative complications. Wound closure was faster with KBS than with SS in equine bilateral inguinal castration. Our results show that KBS can safely be used in the horse following bilateral inguinal castrations without adverse effects and with a reduction in suturing time.

Ovariectomy/Orchiectomy in Rodents.

This chapter describes the surgical procedures for ovariectomy and orchiectomy in mice and rats. In addition to providing technical details of the surgical techniques, details of anesthesia options and pre-, peri-, and postoperative care are also included.

Prevalence of complications associated with use of the Henderson equine castrating instrument.

BACKGROUND: Castration is one of the most common surgical procedures performed in the horse. Complication rate and types of complications associated with use of the Henderson equine castrating instrument have not been determined. OBJECTIVE: To determine the complication rate and type of complications encountered when using the Henderson equine castrating instrument in equine ambulatory practice. STUDY DESIGN: Retrospective case series. METHODS: Medical records of horses undergoing routine castration using the Henderson drill were identified and evaluated for the occurrence of complications. The relationship between potential risk factors and complications was examined using basic descriptive statistics and quantified by means of logistic regression. RESULTS: Of 252 horses in the study population, 27 (10.7%) developed a complication after surgery; 25 of which were nonlife-threatening and responded to medical management. Two complications, one each of wound botulism and evisceration, resulted in euthanasia. Age at the time of castration was significantly associated with the occurrence of (P = 0.005, Wilcoxon rank sum test) complications. Compared to younger horses, the odds of having a complication were significantly greater (OR 2.99, 95% CI 1.27-7.0; P = 0.01) for horses of 4 years of age or more. MAIN LIMITATIONS: The retrospective nature of this study. There is also a lack of direct comparison between different castration methods. CONCLUSIONS: The Henderson equine castrating instrument is an acceptable alternative to traditional emasculators. Its use is associated with a low rate of complications (8.3%) in young horses (≤3 years of age) compared to older horses (21.3%) and a very low rate of serious complications (0.8%) in all ages of horses.

[Evaluation of a field-suitable injection anesthesia protocol for the castration of 8 to 14 days old piglets]. / Ermittlung eines feldtauglichen Injektionsanästhesieprotokolls zur Kastration von 8 bis 14-tägigen Ferkeln.

INTRODUCTION: The aim of this study was to find an intramuscularly (IM) injectable anaesthetic combination for 8 to 14-days old piglets, that guarantees a calm induction and sufficient quality of anaesthesia without excitations with a maximum of two hours long lasting recovery. In preliminary dose finding trials, different combinations of -ketamine, azaperone and romifidine were compared. A constant dose of 0.2 mg/kg of butorphanol was added to each combination and all piglets received 0.4 mg/kg meloxicam. Subsequently a dosage algorithm for the main trial was developed. In case of insufficient analgesia, lidocaine 2% (0.25 ml) was injected intratesticular. If two piglets showed an insufficient anaesthetic induction phase, depth of anaesthesia or recovery, the next dosage in the algorithm was tried. With the combination of 3 mg/kg azaperone, 0.2 mg/kg romifidine, 15 mg/kg ketamine and 0.2 mg/kg butorphanol the requirement of a smooth anaesthesia induction, sufficient anaesthesia and a recovery without excitation was fulfilled but the recovery lasted more than 120 minutes.

INTRODUCTION: Le but de la présente étude était de mettre au point une combinaison d'anesthésiques injectables par voie intra-musculaire pour les porcelets âgés de 8 à 14 jours qui garantisse une induction calme, une qualité d'anesthésie suffisante (sans mouvement de défense durant l'intervention) et une phase de réveil dépourvue d'excitation et ne durant pas plus de deux heures. Dans le cadre d'un essai préliminaire, on a comparé, afin de définir les doses respectives, des combinaisons de kétamine, d'azapérone et de romifidine. Les résultats ont servi de base pour l'algorithme de dosage de l'essai principal. Les dosages testés étaient les suivants : 1, 2 ou 3 mg/kg d'azapérone, 10 ou 15 mg/kg de kétamine et 0.15 ou 0.2 mg/kg de romifidine. En outre, tous les animaux recevaient du méloxicam (0.4 mg/kg) et du butorphanol (0.2 mg/kg) IM. En cas d'analgésie insuffisante, de la lidocaïne 2% (0.25 ml) était appliquée en intra-testiculaire. Si deux porcelets montraient une phase d'induction, de castration ou de réveil insuffisante, on passait au dosage suivant. Avec la combinaison de 3 mg/kg d'azapérone, 0.2 mg/kg de romifidine, 15 mg/kg de kétamine et de 0.2 mg/kg de butorphanol, les exigences d'une induction calme, d'une qualité d'anesthésie suffisante et d'un réveil dépourvu d'excitation étaient remplies. Toutefois les porcelets dormaient plus de 120 minutes.

Do different characteristics of two emasculators make a difference in equine castration?

BACKGROUND: The Serra and Reimer emasculators are frequently used in equine orchiectomy. They differ in jaw profile and the mechanism by which they achieve haemostasis. OBJECTIVES: To investigate whether the haemostatic capacities of the Reimer and Serra emasculators in open and closed castration differ, to compare the haemostatic capacities of each emasculator in both open and closed castration, and to assess whether the tensile strength of the parietal tunic in closed castration differs according to whether a Reimer or Serra emasculator is used. STUDY DESIGN: Ex vivo randomised study. METHODS: Eighty equine cadaver testes were randomly assigned to two groups for, respectively, open and closed castration. Each group was divided into two subgroups for castration with a Serra or Reimer castrator, respectively. Testicular artery leaking pressure was measured by dye injection. In closed castration, the tensile strength of the parietal tunic was measured with a tensiometer. RESULTS: In open castration, the Reimer emasculator resisted significantly higher pressure (median: 706.1 mmHg; interquartile range [IQR]: 597.6-735.5 mmHg) than the Serra emasculator (median: 349.4 mmHg; IQR: 261.1-468.9 mmHg) (P<0.001), whereas no difference was found in closed castration (Serra emasculator, median: 382.5 mmHg [IQR: 294.2-568.2 mmHg]; Reimer emasculator, median: 419.2 mmHg [IQR: 294.2-616.0 mmHg]). The Reimer emasculator resisted significantly higher pressure in the open (median: 706.1 mmHg; IQR: 597.6-735.5 mmHg) compared with the closed (median: 419.2 mmHg; IQR: 294.2-616.0 mmHg) technique (P = 0.03). Parietal tunic tensile strength did not differ significantly by emasculator (mean ± s.d.: Serra, 12.65 ± 7.35; Reimer, 17.55 ± 11.76). MAIN LIMITATIONS: Limitations are inherent to the ex vivo study design. Post-surgery implications were investigated only in the short term and no account was taken of tissue inflammation and oedema, which may influence the integrity of the tissue. CONCLUSIONS: These results suggest it may be preferable to use a Reimer emasculator in open castration. In this ex vivo model of closed castration, no differences between the emasculators were observed.

THE USE OF THE LIGASURE™ DEVICE FOR SCROTAL ABLATION IN MARSUPIALS.

Five sugar gliders ( Petaurus breviceps ), ranging in age from 3 mo to 3.5 yr of age, and one opossum ( Didelphis virginianus ), age 4.5 mo, presented for elective orchiectomy and scrotal ablation. The LigaSure™ device was safely used for orchiectomy and scrotal ablation in both species. Surgical time with the LigaSure was approximately 4 sec. No grooming of the incision site or self-mutilation was seen in the first 72 hr postoperatively. One sugar glider required postoperative wound care approximately 10 days postoperatively following incision-site grooming by a conspecific. The LigaSure provides a rapid, technologically simple and safe surgical technique for scrotal ablation and orchiectomy in the marsupial patient that minimizes surgical, anesthetic, and recovery times.

Neoplasias hematológicas con implicación testicular / Hematologic neoplasms with testicular involvement

OBJETIVO: Presentamos dos casos de pacientes diagnosticados de tumor hematológico que presentan recidiva a nivel testicular, realizamos la revisión de la literatura en relación a lo infrecuente de dicha patología. MÉTODOS: Revisión retrospectiva de la historia clínica de dos pacientes diagnosticados de neoplasias hematológicas (Leucemia Mieloblástica Aguda y Mieloma múltiple) con aparición de recidiva a nivel testicular. Revisamos el manejo y resultado tras tratamiento mediante orquiectomía bilateral. RESULTADO: Caso 1: Paciente diagnosticado de Leucemia mieloblástica aguda tratada mediante trasplante alogénico. Dos años después el paciente refiere aumento del tamaño testicular. En estudios complementarios se sospecha recidiva a nivel testicular que tras orquiectomía se confirma. Actualmente se encuentra a la espera de tratamiento quimioterápico previo a nuevo trasplante alogénico. Caso 2: Paciente diagnosticado de Mieloma Múltiple que inicia tratamiento poliquimioterápico sin respuesta, se realiza trasplante alogénico. Tras cinco meses de remisión completa se evidencian signos de recidiva sistémica realizándose estudio para nuevo trasplante. Durante el mismo se objetiva posible recidiva a nivel testicular. Tras pruebas complementarias se realiza orquiectomía bilateral y se confirma el diagnóstico. Actualmente el paciente se encuentra en protocolo de trasplante alogénico tras tratamiento radio y quimioterápico. CONCLUSIONES: Actualmente el porcentaje de mortalidad, en los casos de recidiva a nivel testicular secundaria a neoplasia hematológica, ha disminuido pese al marcado aumento de su incidencia. Esto se debe, como en nuestros casos, a un diagnóstico precoz y al uso combinado de quimioterapia, radioterapia y cirugía. Esto se logra a través de un trabajo interdisciplinario entre urólogos, hematólogos, oncólogos y radioterapeutas

OBJECTIVE: We report two cases of patients with a previous diagnosis of hematologic tumor who present with testicular recurrence, and we carry out a review of the literature regarding the infrequency of this pathology. METHODS: We present a retrospective review of the medical records of two patients diagnosed with hematologic malignancies (acute myelogenous leukemia and multiple myeloma) with occurrence of relapse in the testicle. We reviewed the management and outcome after treatment with bilateral orchiectomy. RESULTS: Case 1: The patient was diagnosed with acute myeloid leukemia and treated with an allogeneic transplant. Two years later, the patient reported an increase in testicular size. The complementary studies lead us to suspect a testicular recurrence that was confirmed after orchiectomy. Currently, the patient awaits the start of a chemotherapy treatment prior to a new allogeneic transplant. Case 2: Patient with the diagnosis of multiple myeloma who started a polychemotherapy treatment without response and underwent allogeneic transplant. After five months with complete remission, there were signs of systemic recurrence, and a study for a new transplant was carried out. During the study, potential testicular recurrence was observed. After a batch of complementary tests, bilateral orchiectomy was performed and the diagnosis was confirmed. Currently, the patient is undergoing an allogeneic transplant protocol after radiotherapy and chemotherapy treatment. CONCLUSIONS: Currently the mortality rate in cases of relapse of hematologic malignancy in the testicle has declined despite the sharp rise in its incidence. This is because of, as in our case, early diagnosis and the combined use of chemotherapy, radiotherapy and surgery. This has been achieved through an interdisciplinary collaboration of urologists, hematologists, oncologists and radiotherapists

Influence of hands-on experience on pig farmers' attitude towards alternatives for surgical castration of male piglets.

This study evaluates the influence of practical experience with alternatives for surgical castration (SC) on farmer attitudes. Nineteen farmers in Flanders were surveyed before (ex-ante) and after (ex-post) performing each of five treatments on farm: 1) SC with analgesia (SCAN); 2) SC with CO2 anaesthesia (SCCO2); 3) immunocastration (IM); 4) production of entire males (EM); and 5) SC without pain relief (SCN). For SCCO2 and SCAN, farmers mainly experienced disadvantages in terms of increased labour, costs and complexity. Hands-on experience promoted EMas a valid alternative for SCN due to the actual and perceived improvement in performance and profitability as well as the reduced labour demands. Experience with IM did not fully fulfil the favourable ex-ante expectations resulting in a level of dissatisfaction and a less favourable general attitude ex-post.

Quiste epidermoide testicular: una rara entidad clínica / Testicular epidermoid cyst: a rare entity

OBJETIVO: El quiste epidermoide testicular es una rara entidad clínica, representando un 1% de las neoplasias testiculares. Método y resultados: Presentamos dos pacientes de 18 y 19 años de edad respectivamente con una lesion indolora a nivel de testículo. Se realiza una ecografía testicular donde se evidencia un nódulo hipoecogénico en ambos casos. Con la sospecha de tumor testicular se realiza una orquiectomía inguinal con colocación de una prótesis testicular en mismo acto. El resultado anatomopatológico fue de quiste epidermoide testicular en los dos casos. CONCLUSIÓN: Los quistes epidermoides testiculares son una rara entidad clínica benigna, que en caso de ser sospechada en función a los marcadores testiculares y la ecografía o la RMN, debe intentarse una cirugía conservadora

OBJECTIVE: Testicular epidermoid cyst is a rare clinical entity that accounts for 1% of testicular neoplasias. METHODS AND RESULTS: We report two cases of testicular epidermoid cysts in a 18 and 19 year old males with a painless testicular lesion. Testicular US was carried out showing a hypoechoic nodule in both cases. With the suspicion of testicular neoplasm inguinal orchiectomy was carried out with placement of testicular prostheses in the same act. The pathology report was testicular epidermoid cyst in both cases. CONCLUSIONS: Testicular epidermoid cysts are an uncommon benign entity. When there is a suspicion of this diagnosis, based on tumor markers and ultrasound or MRI images, testicular parenchyma-sparing surgery must be attempted

Metástasis testicular de melanoma. A propósito de un caso / Metastatic testicular melanoma. Case report

No disponible

Single-port laparoscopic cryptorchidectomy in dogs and cats: 25 cases (2009-2014).

OBJECTIVE: To describe the operative technique for single-port laparoscopic cryptorchidectomy (SPLC) in dogs and cats and evaluate clinical outcome for patients that underwent the procedure. DESIGN: Retrospective case series. ANIMALS: 25 client-owned dogs (n = 22) and cats (3). PROCEDURES: Dogs and cats that underwent SPLC with 3 commercially available single-port devices between 2009 and 2014 were retrospectively identified through a multi-institutional medical records review. Surgery was performed via a single-port device placed through a 1.5- to 3.0-cm abdominal incision either at the region of the umbilicus or caudal to the right 13th rib. The cryptorchidectomy was performed with graspers, a bipolar vessel sealing device, and a 30° telescope. RESULTS: SPLC was performed with a single-incision laparoscopic surgery port (n = 15), a multitrocar wound-retractor access system (8), or a metal resterilizable single-port access device (2). Median age was 365 days (range, 166 to 3,285 days). Median body weight was 18.9 kg (41.6 lb; range, 1.3 to 70 kg [2.9 to 154 lb]). Median surgical time was 38 minutes (range, 15 to 70 minutes). Thirty-two testes were removed (12 left, 6 right, and 7 bilateral). Four patients had 1 additional abdominal surgical procedure performed concurrently during SPLC. No intraoperative or postoperative complications were encountered. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that SPLC can be performed in a wide range of dogs and cats with cryptorchidism and can be combined with other elective laparoscopic surgical procedures. The SPLC technique was associated with a low morbidity rate and provided a potentially less invasive alternative to traditional open and multiport laparoscopic techniques.

Labour time required for piglet castration with isoflurane-anaesthesia using shared and stationary inhaler devices.

Isoflurane-anaesthesia combined with an analgesic represents a welfare-friendly method of pain mitigation for castration of piglets. However, it requires an inhaler device, which is uneconomic for small farms. Sharing a device among farms may be an economical option if the shared use does not increase labour time and the resulting costs. This study aimed to investigate the amount and components of labour time required for piglet castration with isoflurane anaesthesia performed with stationary and shared devices. Piglets (N = 1579) were anaesthetised with isoflurane (using either stationary or shared devices) and castrated.The stationary devices were used in a group (n = 5) of larger farms (84 sows/farm on an average), whereas smaller farms (n = 7; 32 sows/farm on an average) shared one device. Each farm was visited four times and labour time for each process-step was recorded. The complete process included machine set-up, anaesthesia and castration by a practitioner, and preparation, collection and transport of piglets by a farmer. Labour time of the complete process was increased (P = 0.012) on farms sharing a device (266 s/piglet) compared to farms using stationary devices (177 s/ piglet), due to increased time for preparation (P = 0.055), castration (P = 0.026) and packing (P = 0.010) when sharing a device. However, components of the time budget of farms using stationary or shared devices did not differ significantly (P > 0.05). Cost arising from time spent by farmers did not differ considerably between the use of stationary (0.28 Euro per piglet) and shared (0.26 Euro) devices. It is concluded that costs arising from the increased labour time due to sharing a device can be considered marginal, since the high expenses originating from purchasing an inhaler device are shared among several farms.

Effects of local anesthesia and flunixin meglumine on the acute cortisol response, behavior, and performance of young dairy calves undergoing surgical castration.

This study assessed the effects of flunixin meglumine (FM) and a local anesthetic block (LA) on postcastration performance, plasma cortisol concentration, and behavior in dairy calves. Thirty 2- to 3-mo-old Holstein-Friesian bull calves were allocated to 5 treatments: castration with LA (2% lidocaine injected into the testes and subcutaneously), castration with FM (1.1mg/kg, i.v.), castration with LA+FM, castration without drugs (CC), and sham castration (SC). Castration was performed using a Newberry knife and Henderson castrating tool. Feed intake and body weight gain were recorded for 10d postcastration. Plasma cortisol concentration and behavior frequency and duration were monitored for 8h postcastration. Variables with repeated measures were analyzed using PROC MIXED (SAS Institute Inc., Cary, NC); one-way ANOVA was used for nonrepeated measures. No differences in feed intake or body weight gain were detected among groups. Calves in the CC, LA, and FM groups had transient (<60, <60, and <45 min, respectively) increases in plasma cortisol concentration after castration, with a second increase at 120 min in the LA group, whereas cortisol concentration remained at baseline in the LA+FM and SC groups. Mean cortisol concentrations were lower for calves in the LA+FM and SC groups than in the CC group. The area under the plasma cortisol concentration curve during the first 3h postcastration was greater in CC- and LA-treated calves than in SC controls. Castration without drugs was associated with higher frequencies of crouching and statue standing and less oral activity compared with SC controls. Administering LA alone before castration was associated with higher frequencies of head turning, statue standing, and postural changes, and less feeding behavior compared with SC controls. More leg lifting to groom was seen in LA+FM-treated calves than in SC controls. Calves administered FM alone before castration exhibited less crouching than CC calves, fewer postural shifts, and more feeding behavior than LA-treated calves. In summary, FM alone tended to shorten the duration of cortisol response and reduce crouching after surgical castration. Combining LA+FM eliminated the cortisol response to castration but was associated with more leg lifting behavior. Treatment with LA alone did not mitigate the cortisol response and was associated with several behavioral differences compared with SC, FM-treated, or FM+LA-treated calves. Results suggest that LA alone did not effectively control discomfort in young dairy calves castrated using the Henderson castration tool.

Abscesos testiculares: abordaje quirúrgico. A propósito de 2 casos / Surgical approach to testicular abscesses: A report of 2 cases

El absceso testicular es una enfermedad poco frecuente, y la mayoría de los casos son una complicación de casos avanzados o no tratados de orquiepididimitis. Los síntomas clínicos y la exploración física no siempre permiten un diagnóstico de certeza, ya que el dolor y la inflamación limitan la palpación correcta del contenido escrotal. De ahí que la ecografía escrotal sea la técnica de imagen de primera elección para determinar la naturaleza de una masa escrotal y también para detectar la presencia de abscesos escrotales. Aunque el tratamiento inicial es médico, en ocasiones hay que recurrir a la orquiectomía. El objetivo de este trabajo es proponer el abordaje inguinal para el tratamiento quirúrgico de los abscesos testiculares, el cual permite mantener aislado el proceso infeccioso y evitar la «violación del escroto» en caso de tratarse de un tumor. Presentamos 2 casos de absceso testicular tratados de manera satisfactoria mediante orquiectomía inguinal (AU)

Testicular abscess is a rare condition that often arises due to complications of untreated or advanced orchiepididymitis. Clinical symptoms and physical exam do not always provide an accurate diagnosis because the pain and swelling often limit adequate palpation of the scrotal contents. Therefore, scrotal ultrasound is the imaging technique of choice to determine the nature of the scrotal mass and also to detect presence of scrotal abscesses. Although initial treatment is medical, it is sometimes necessary to resort to orchiectomy. This purpose of this paper is to propose inguinal approach for the surgical treatment of testicular abscesses. This approach makes it possible to maintain the infectious process isolated and thus avoid ‘‘violation of the scrotum’’ in the case of a tumor.We report two cases of testicular abscess successfully treated by inguinal orchiectomy (AU)

Coelioscopic orchiectomy can be effectively and safely accomplished in chelonians.

Coelioscopic orchiectomy was performed in 27 male turtles (25 juvenile to adult red-eared sliders (Trachemys scripta elegans), one adult eastern painted turtle (Chrysems picta picta), and one juvenile male yellow-spotted Amazon River turtle (Podocnemis unifilis)). Orchiectomy was conducted under coelioscopic visualisation using ligation and transection of the mesorchium, or transection of the mesorchium with monopolar radiosurgical scissors. In 22 cases, bilateral orchiectomy was performed through a single incision; five turtles required bilateral incisions. All turtles recovered from anaesthesia. Nine turtles died within one year of surgery from conditions believed to be unrelated to surgery. One turtle was lost to follow-up. Seventeen turtles remain clinically healthy one to three years postoperatively. Coelioscopic orchiectomy provides a minimally invasive method for sterilisation of male chelonians and provides excellent visualisation during surgery. This technique is a useful model for the development of additional minimally invasive surgical techniques for chelonians.

Radomiosarcoma paratesticular: a propósito de un caso / Paratesticular phabdomyosarcoma: a case report

OBJETIVO: Presentar un caso de radomiosarcoma paratesticular y revisión de la literatura. MÉTODOS: Describimos el caso de un varón de 16 años remitido a nuestro servicio por masa paratesticular izquierda de crecimiento progresivo, con imagen ecográfica de tumoración paratesticular heterogénea con flujo Doppler en su interior. RESULTADOS: Se realizó orquiectomía izquierda, con diagnóstico de rabdomiosarcoma. El paciente rechazó el tratamiento quimioterápico adyuvante. Tras 13 meses libre de enfermedad, reingresó por dolor cólico izquierdo detectándose en ecografía y TC una masa retroperitoneal paraaórtica izquierda que condicionaba uréterohidronefrosis grado III, y metástasis pulmonares. A pesar de instaurarse quimioterapia de rescate, no respondió presentando rápida progresión de la masa abdominal con importante deterioro general que no permitió el abordaje quirúrgico, siendo éxitus a las pocas semanas. CONCLUSIÓN: Los sarcomas paratesticulares son tumores infrecuentes y de mal pronóstico(AU)

OBJECTIVE: To report a case of paratesticular rhadomyosarcoma and to perform a bibliographic review. METHODS: We report the case of a 16-year-old male referred to our Department because of a left paratesticular hard tumor with progressive growth. Ultrasound examination showed a paratesticular heterogeneous mass with Internal flow on Doppler. RESULTS: The patient underwent left inguinal orchiectomy, with pathological diagnosis of rhabdomyosarcoma. He refused adjuvant chemotherapy. After being disease-free for 13 months, he presented with left colic pain. Ultrasound and CT examinations showed a left paraaortic retroperitoneal mass causing grade III ureterohydronephrosis, and lung metastases. Despite rescue chemotherapy treatment, there was no response and the abdominal mass progressed. A surgical approach was not possible since patient showed a rapid clinical worsening leading to his death a few weeks later. CONCLUSIONS: Paratesticular sarcomas are very uncommon tumors with poor prognosis(AU)

Umbilical KeyPort bilateral laparoscopic orchiectomy in patient with complete androgen insensitivity syndrome.

MAIN FINDINGS: A 22-year-old woman with complete androgen insensitivity syndrome (CAIS) presenting with primary amenorrhea and normal female external genitalia was referred for laparoscopic gonadectomy. She had been diagnosed several years earlier but was reluctant to undergo surgery. Case HYPOTHESIS: Diagnosis of this X-linked recessive inherited syndrome characterizes by disturbance of virilization in males with an AR mutation, XY karyotipe, female genitalia and severely undescended testis with risk of malignization. The optimal time to orchidectomy is not settled; neither the real risk of malignancy in these patients. Early surgery impacts development of a complete female phenotype, with enlargement of the breasts. Based on modern diagnostic imaging using DCE-MRI and surgical technology with single port laparoscopic access we hypothesize that the optimum time for gonadectomy is not at the time of diagnosis, but once feminization has completed. PROMISING FUTURE IMPLICATIONS: An umbilical laparoendoscopic single-site access for bilateral gonadectomy appears to be the first choice approach as leaves no visible incision and diminishes the psychological impact of surgery in a patient with CAIS absolutely reassured as female. KeyPort, a single port access with duo-rotate instruments developed by Richard Wolf facilitates this surgery and allows excellent cosmetic results.

Tumor testicular / Testicular tumour

Se presenta un caso de tumor de células germinales testiculares, neoplasia poco usual que se caracteriza por afectar a personas jóvenes y tener una gran capacidad de diferenciación. Se trata de un varón de 37 años que acude por palparse una tumoración dolorosa en testículo derecho tras recibir un balonazo. A la exploración, en el testículo derecho se palpa un nódulo de consistencia dura, pétrea, adherido a planos profundos. Una vez derivado a Urología y confirmada por ecografía la tumoración se le realiza una orquiectomía radical derecha. El diagnóstico anatomopatológico es de seminoma clásico con intensa reacción sarcoidea y extensión a las cubiertas testiculares, al epidídimo y a la parte proximal del cordón (AU)

A case of a testicular germ cell tumour arises, an unusual neoplasia characterized by the fact that it affects young people and having a great ability for differentiation. It involves a 37 year old male seeking medical care on feeling a painful growth in his right testicle after being hit by a ball. On examination, a hard, stony nodule can be felt in the right testicle, with deep layer adherence. On referral to urology, and after ultrasound confirmation of the growth, a radical orchiectomy is performed. The histopathological diagnosis is for classic seminoma with an intense sarcoid reaction, extending to the coverings of the testis, epididymis and to the proximal portion of the cord (AU)

Umbilical KeyPort bilateral laparoscopic orchiectomy in patient with complete androgen insensitivity syndrome

MAIN FINDINGS: A 22-year-old woman with complete androgen insensitivity syndrome (CAIS) presenting with primary amenorrhea and normal female external genitalia was referred for laparoscopic gonadectomy. She had been diagnosed several years earlier but was reluctant to undergo surgery. CASE HYPOTHESIS: Diagnosis of this X-linked recessive inherited syndrome characterizes by disturbance of virilization in males with an AR mutation, XY karyotipe, female genitalia and severely undescended testis with risk of malignization. The optimal time to orchidectomy is not settled; neither the real risk of malignancy in these patients. Early surgery impacts development of a complete female phenotype, with enlargement of the breasts. Based on modern diagnostic imaging using DCE-MRI and surgical technology with single port laparoscopic access we hypothesize that the optimum time for gonadectomy is not at the time of diagnosis, but once feminization has completed. PROMISING FUTURE IMPLICATIONS: An umbilical laparoendoscopic single-site access for bilateral gonadectomy appears to be the first choice approach as leaves no visible incision and diminishes the psychological impact of surgery in a patient with CAIS absolutely reassured as female. KeyPort, a single port access with duo-rotate instruments developed by Richard Wolf facilitates this surgery and allows excellent cosmetic results.