PROCEDURES PERFORMED: 1. Bilateral scrotal exploration 2. Left testicular detorsion 3. Bilateral orc

PROCEDURES PERFORMED: 1. Bilateral scrotal exploration 2. Left testicular detorsion 3. Bilateral orchiopexy INDICATIONS FOR PROCEDURE: The patient is a 15-year-old gentleman who presented after he woke up this morning with complaint of left scrotal pain. He was seen in emergency department, and once we were consulted and after evaluating him emergently, we took him to the operating room for scrotal exploration and detorsion and orchiopexies. I discussed with the patient and his mother the risks, benefits, potential complications, and alternatives of the procedure. She verbalized understanding and gave an informed consent. DESCRIPTION OF PROCEDURE: The patient was identified in the holding area by name and medical record number and then taken back to operating suite, where he was placed in supine position. All appropriate monitoring lines were placed. General anesthesia was induced without any difficulty. The area was then prepped and draped in the standard sterile fashion. To start the procedure, an anterior transverse incision was made overlying the left scrotum, and this was carried down through the dartos fascia, down to the tunica vaginalis. At this point, the testicle and cord were delivered through the incision, and then the patient was noted to have essentially a 180- to 360-degree torsion with the testicle noted to be dark and hard. Once the tunica vaginalis was opened, the testicle was noted to be dark, and then I started investigating the anatomic structures. Of note, the patient’s scrotum did not have a defined epididymal head, and I could not feel the vas join into the testicle. It essentially felt as if the vas became atretic as it approached the testicle itself, without a clear-cut connection to the testicle. After examining the testicle, we proceeded to wrap this in warm gauze, and then I turned my attention to the right hemiscrotum. Again another transverse incision was made and carried down to the dartos. I then delivered the testicle on this side. This side was normal. Then a pexing stitch was placed through the dartos without button-holing the skin. Once this was done on both sides, it was also placed through tunica albuginea of the testicle. The testicle was then carefully replaced back into the sac with maintaining the lateral sulcus lateral and ensuring that the cord had no twisting. Once the testicle was placed in the sac, the sutures were tied down, then the dartos was closed with a 3-0 chromic suture, and the skin was closed with 4-0 Monocryl suture placed in subcuticular fashion. After this side was done, we waited and then essentially I consulted with the doctor who was originally consulted about this patient’s case, he advised to incise the tunica albuginea to examine the tubules, and if the tubules are seen to be viable, then proceed to save the testicle. At this point, the testicle looked marginal and was not completely normal. It looked as if portions of it were viable. I made an incision on the tunica albuginea, over the areas that looked viable, and then exposed the tubules and noted that it was tan-colored and looked as if it was viable. Some bleeding was noted. At that point, I decided to proceed with saving this side. I closed the incision with a 5-0 chromic suture in a figure-of-eight fashion and then proceeded to pex this side in the same fashion as the other side. Once the apexion was completed, again the dartos was closed with 3-0 chromic suture and the skin was closed with 4-0 Monocryl suture placed in subcuticular fashion. After this was done, local anesthesia was applied to the skin and then Dermabond was also applied to the skin. A fluff dressing as well as scrotal support was placed, and then at this point the procedure was then complete. The patient was then awoken and transferred back to the post anesthesia care unit, where he continued to recover without any difficulty. The ICD-10-PCS Code is: _______.

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