Controversial.
Generally – no role in the patient with a normal contralateral testis.
Consider in:
- Single testis
- Bilateral synchronous tumours
- Smaller tumours < 2 – 3 cm, in the above settings
- ?? high suspicion of benign lesion < 3 cm
Intra-operatively:
- Frozen section essentially mandatory
- Strongly consider biopsies to exclude GCNIS
Technically:
- Deliver testis through inguinal incision a la radical orchidectomy
- Clamp cord (rubber shods or atraumatic vascular clamp)
- Excise mass sharply. Consider ultrasound. Frozen section.
- Close tunica albuginea with 4-0 PDS.
- Bipolar cautery could be helpful.
- Consider intra-operative biopsies for GCNIS.
Consider banking some normal seminiferous tubules at the time if appropriate, although only if ejaculated sperm is unavailable or insufficient.