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    Cord denervation: Surgeons describe microsurgical techniques in men with scrotal pain


    Microscopic spermatic cord denervation - James Craig, MD, and James M. Hotaling, MD, MS





    We demonstrate the technique we use at our Men’s Health Center in Utah for optimal cord denervation. Like many others, we use a small subinguinal incision. However, we improve our exposure in obese patients by using the hooks from a Lone Star retractor to facilitate exposure. Here, Dr. Craig begins by identifying the lymphatics and preserving these with vessel loops. He uses a micro needle driver for much of the fine dissection to preserve fragile tissue planes and identify the artery, which he then places a vessel loop around. We transect the vas deferens in all men who are done having children. At the end of the procedure, we have only three lymphatics and the artery. Although we do not demonstrate it in this video, we also use Amniofix (a technique learned from Dr. Shridharani) and have found that our success rates have gone from 80% to 90% since use of this adjunct.

    James Craig, MDJames Craig, MD James M. Hotaling, MD, MSJames M. Hotaling, MD, MS

    Dr. Craig is a men's health and reconstructive urology fellow, and Dr. Hotaling is assistant professor of surgery (urology) at the Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City.



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