Name: microscopic cyst resection for the treatment of patients diagnosed with epididymal cyst
Uploaded: 2023-03-31T13:20:00
Description: Watch this Scientific Journal Video about Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst at JoVE.com

This study was supported by health science and technology projects in Yunnan Province (NO.2018NS0256) and training objects of medical subject leaders in Yunnan Province (NO. D-2018039)

We performed retrospective analysis of the clinical data of male patients, initially diagnosed with epididymal cysts, admitted to the urology inpatient department of the Affiliated Hospital of Kunming University of Technology (the First People&#39;s Hospital of Yunnan Province). Written, informed consent must be obtained from patients before surgery.
1. Clinical inclusion and exclusion criteria
<ol>
	<li>Include patients who are below 45 years of age and have a need to prese...

<ol>
	<li>Jelloul, L., Billerey, C., Ait Ali Slimane, M., Mboyo, A., Aubert, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epididymal+cysts+in+adolescents.">Epididymal cysts in adolescents.</a> Annales d'Urologie. 33 (2), 104-108 (1999).</li><li>Boscarelli, A., Bellini, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epididymal+cyst+in+children.">Epididymal cyst in children.</a> European Journal of Pediatrics. 180 (9), 2723-2729 (2021).</li><li>Yong-Bao, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+efficacy+and+safety+of+scrotoscope+in+the+treatment+of+masses+in+caput+epididymidis.">The efficacy and safety of scrotoscope in the treatment of masses in caput epididymidis.</a> Journal of Trauma and Emergency Surgery. 6 (4), 208-211 (2018).</li><li>Erikci, V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+epididymal+cysts+in+childhood.">Management of epididymal cysts in childhood.</a> Journal of Pediatric Surgery. 48 (10), 2153-2156 (2013).</li><li>Zhen-Chao, L., Xing-You, Q., Rong-De, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosis+value+of+high+frequency+color+doppler+ultrasound+for+epididymis+cyst.">Diagnosis value of high frequency color doppler ultrasound for epididymis cyst.</a> China Modern Medicine. 20 (3), 102-103 (2013).</li><li>Sinha, V., Shankar, M., Sardana, N., Aggarwal, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+rare+case+of+epididymal+cyst+due+to+schistosomiasis.">A rare case of epididymal cyst due to schistosomiasis.</a> Cureus. 11 (9), e5755 (2019).</li><li>Mukendi, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bilateral+spontaneous+resolution.">Bilateral spontaneous resolution.</a> Clinical Case Reports. 8 (12), 2689-2691 (2020).</li><li>Patoulias, D., Kalogirou, M., Patoulias, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraparenchymal+4+cm+in+diameter+in+a+15-year+old+male+patient;+a+case+report+and+review+of+the+literature.">Intraparenchymal 4 cm in diameter in a 15-year old male patient; a case report and review of the literature.</a> Acta Medica. 59 (4), 137-139 (2016).</li><li>Sun-Biao, L., Meng, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+analysis+of+43+epididymal+mass+patients.">Clinical analysis of 43 epididymal mass patients.</a> Fujian Medical Journal. 31 (3), 32-33 (2009).</li><li>Wang, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+for+childhood+herniorrhaphy.">Treatment for childhood herniorrhaphy.</a> Urology. 112, 80-84 (2018).</li><li>Ory, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Predictors+of+success+after+bilateral+during+vasectomy+reversal:+A+multi-institutional+analysis.">Predictors of success after bilateral during vasectomy reversal: A multi-institutional analysis.</a> Canadian Urological Association Journal. 16 (3), E132-E136 (2022).</li></ol>

As we mentioned previously, epididymal cysts mostly occur in men aged 20 to 40 years, while there is also some literature on epididymal cysts in childhood1,2. To date, the cause of epididymal cysts is not clear, and there is no specific medicine for its treatment. In addition to a few reports that epididymal cysts can resolve spontaneously without surgery7, most epididymal cysts, although their progression and enlargement are relatively sl...

Epididymal cysts mostly occur in men aged 20-40 years old, although some literature also exists concerning epididymal cysts in childhood1,2. Previous reports have covered concerns about surgical destruction and postoperative scarring in patients undertaking nonmicroscopic epididymal cyst resection or epididymal resection3,4. Other postoperative complexes include seminal tract obstruction, immune infertility, and testicular atrophy. There is also a higher risk for postoperative occurrence, and even recurrence, of hematoma, edema, and a sustaining pain and cyst5,6. There are also reports that epididymal cysts can resolve spontaneously without surgery7. As a result, previous studies have concluded that epididymal cysts do not lead to testicular network expansion without intervention, and puncture or surgical treatment can be considered if epididymal cysts combine with testicular network expansion or damage of the proximal vas deferens2,4. Further, some investigators believe that patients with large epididymal cysts combined with pain are also suitable for surgical resection8. The treatment of epididymal cysts by puncture alone is prone to relapse. Traditional (nonmicroscopic) cyst resection or epididymectomy may destroy the epididymal canal, leading to epididymal obstruction, immune infertility, or even testicular atrophy; therefore, one should be cautious for young patients with fertility requirements2,9. Patients with childbirth plans are recommended to choose traditional (nonmicroscopic) epididymal cyst surgery as a cautionary measure. 
Microsurgical methods have been widely used in the treatment of vas deferens obstruction and epididymal obstruction, with excellent results10,11. The treatment of male epididymal cysts via microtechnology may be a beneficial option, however the necessity of extending microtechnology treatment to male epididymal cysts is questionable. We took the lead in carrying out microscopic epididymal exploration and cyst resection surgery in China. We carried out retrospective analysis of the clinical data of male patients, initially diagnosed with epididymal cysts, admitted to the urology inpatient department of the Affiliated Hospital of Kunming University of Technology (the First People's Hospital of Yunnan Province) between September 2017 and April 2019. The patients were younger than 45 years old and required fertility preservation. Based on microscopic manipulation, which largely improved visualization of the subtle tissue structures of the epididymis, the cyst could be clearly dissected apart and completely removed intact.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Ablation electrode</td>
			<td>Baisheng Medical Devices Co., Ltd. China</td>
			<td>OBS-Db</td>
			<td></td>
		</tr>
		<tr>
			<td>Anesthesia apparatus</td>
			<td>Datex-Ohmeda,Inc.USA</td>
			<td>Aespire View, Datex-Ohmeda</td>
			<td></td>
		</tr>
		<tr>
			<td>Compact Anesthesia Monitor</td>
			<td>GE Healthcare Finland OY.Finland</td>
			<td>S/5 Compact</td>
			<td></td>
		</tr>
		<tr>
			<td>&#160;Electric knife</td>
			<td>Valleylab.USA</td>
			<td>Valleylab Force FX-8C</td>
			<td></td>
		</tr>
		<tr>
			<td>Surgical (operation) microscope</td>
			<td>Lecia Microsysterms (Schweiz) AG. Germany</td>
			<td>Lecia M525 F20</td>
			<td></td>
		</tr>
	</tbody>
</table>

microscopic cyst resection for the treatment of patients diagnosed with epididymal cyst

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative asoedema, hematoma, sustaining pain, and seminal tract obstruction in patients who have undertaken nonmicroscopic epididymal cyst resection or epididymal resection. Nonmicroscopic epididymal cyst surgery is suggested for patients with childbirth plans as a precaution. The treatment of male epididymal cysts via microtechnology is obviously a beneficial option; we took the lead in carrying out microscopic epididymal exploration and cyst resection surgery in China. From September 2017 to April 2021, 41 young and middle-aged male patients diagnosed with epididymal cysts underwent microtechnology treatment in a program titled &#34;microscopic epididymal exploration and cystectomy&#34;. The postoperative follow-up lasted for 3-50 months. The results confirmed that, as microscopic manipulation largely improved visualization of the subtle tissue structures of the epididymis, the cyst could be clearly dissected apart and completely removed intact under the microscope. Bleeding during the operation was significantly reduced (2-3 mL) and wound drainage was not required. According to follow-up data, microscopic treatment significantly reduced the incidence of postoperative scrotal hematoma, edema, and long-term postoperative pain, thereby promising a higher surgical success rate as well as recurrence prevention. Besides, preliminary experience and reflection suggest that microscopic epididymal exploration and cystectomy provide efficient preservation of the epididymal patency through refined treatment, while a better prognosis can be achieved. We recommend that surgery be carried out before the epididymal cyst develops to 0.8 cm in diameter, for fear that a larger epididymal cyst (&#62;0.9 cm in diameter) could cause the complete destruction of all tubules of the ipsilateral epididymis - a more severe case with damage to the testicular output network.

From September 2017 to April 2021, 41 young and middle-aged male patients diagnosed with epididymal cysts underwent microtechnology treatment in a program titled &#34;microscopic epididymal exploration and cystectomy.&#34;
Here, we show the data from a single patient as a representative example. The patient was operated on for descending surgery (testicular and epididymal exploration and microscopic cyst removal) under general anesthesia. A scrotal incision was made, the testicular sheath was ...

Watch this Scientific Journal Video about Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst at JoVE.com

Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst

Here, we present a protocol to treat patients diagnosed with an epididymal cyst using microscopic cyst resection. Based on microscopic manipulation, a largely improved visualization of the subtle tissue structures of the epididymis was obtained, so the cyst could be clearly dissected apart and completely removed intact.

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative ...

Here, we present a protocol to treat patients diagnosed with an epididymal cyst using microscopic cyst resection. Based on microscopic manipulation, a largely improved visualization of the epididymis, subtle tissue structures was obtained, enabling accurate dissection and intact removal. To begin, examine the epididymal cord under 6x to 10x power magnification.Using an electric knife, cut the epididymal capsule at the base of the epididymal cyst and normal epididymal tissue. Open the epididymal capsule carefully, and avoid opening the epididymal cyst cavity. After microseparating the epididymal cyst along the cyst wall, carefully isolate the epididymal tissue surrounding the base of the epididymal cyst.Then microseparate the epididymal cyst from its base and the gap between it and the normal epididymal tissue. After occluding the epididymal tissue with a microvascular clamp or ligation with a 7 or 6-0 microsuture, excise the epididymal cyst from the base with microscissors or an electric knife. The represented data are derived from the 41 patients included in this study.All epididymal cysts were completely removed within 30 to 50 minutes of the procedure. Bleeding during the operation was significantly reduced, and wound drainage was no longer required. The postoperative follow-up lasted for 3 to 50 months.The surgical complications were assessed, and the data are shown here. No patient had a recurrence of the epididymal cyst, and no patient developed a postoperative scrotal hematoma. Only one patient had scrotal surgical site pain.According to the follow-up data, microscopic treatment significantly reduced the incidence of postoperative scrotal hematoma, edema, and long-term postoperative pain, thereby promising a higher surgical success rate and recurrence prevention. When performing this procedure, carefully dissect the separation, avoid epididymal cyst wall breakage, especially on blood epididymal cysts or large epididymal cysts with clear cystic fluid inside.

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Research

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Medicine

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Here, we present a protocol of the transaxillary resection of the first rib for treatment of thoracic outlet syndrome caused by compression of the brachial plexus, subclavian vein and artery.

Thoracic outlet syndrome (TOS) is a common disorder that causes a significant loss of productivity. The transaxillary first rib resection (TFRR) protocol ...

Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst

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Robotic liver surgery has gained more acceptance as a feasible, safe, and effective procedure for the treatment of both benign and malignant indications. However, robotic left hepatectomy is still technically demanding. We describe our surgical technique of a robotic left hepatectomy using indocyanine green fluorescence imaging for a large biliary cyst.

Biliary cysts (BC) are rare congenital dilatations of intra- and extrahepatic parts of the biliary tract and bear a significant risk of carcinogenesis. ...

Vessel-Sparing Microsurgical Longitudinal Intussusception Vasoepididymostomy to Treat Epididymal Obstructive Azoospermia

The epididymis is a common site of obstruction in obstructive azoospermia (OA). Vasoepididymostomy has become an important method for the treatment of epididymal OA since 2000. There are two challenges in classic microscopic vasoepididymostomy. First, anastomosis of the vas deferens and epididymis is performed with double-needle sutures. However, there is a lack of good-quality and cost-effective double-needle sutures in China, which leads to increased difficulty and poor success rates of anastomosis. Second, the separation of the vas deferens does not retain vasculature, although the vas deferens vasculature plays an important role in the blood supply to the vas deferens, epididymis, and testis. This affects the blood supply to the anastomotic area and epididymis.
Therefore, this team has made innovative improvements to address these problems. Good-quality, cost-effective, single-needle sutures, which are easy to purchase in China and other countries, were used in microsurgical longitudinal intussusception vasoepididymostomy. This can optimize the operation procedure and shorten the operation time while ensuring the success rate of the anastomosis. The surgical method of preserving the vas deferens vessels was innovatively proposed because the etiology of epididymal OA is mostly inflammatory in China. The protection of the blood supply to the vas deferens and epididymis is maximized using microsurgical forceps to separate and protect the vasculature. Patency reached 81.7% in the postoperative follow-up, indicating a better surgical treatment effect.

The present protocol describes a vessel-sparing, longitudinal intussusception vasoepididymostomy using readily available single-needle sutures in China, a safe and effective procedure, which may improve patients' patency and natural pregnancy rates.

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The protocol focuses on the steps of radical dissection and the main technical points of resection and reconstruction. At the same time, a procedure for fixing an anvil seat by self-traction of extracorporeal silk thread, used for purse-string suture fixation after the proximal anvil was placed in the abdominal cavity, was creatively improved. This operation could effectively avoid problems such as an insufficient proximal intestinal tube, shaking off the anvil seat, and weak purse-string suture during a single operation. The surgical care had less variability and was easy to perform, effectively avoiding postoperative anastomotic leakage and bleeding due to excessive intraoperative anastomotic tissue. This surgery could be widely promoted in primary hospitals.

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This protocol presents a case of a robotic partial duodenal resection with primary side-to-side duodeno-jejunal reconstruction in a patient with a 5 cm duodenal stenosis. This is done at the third duodenal segment (D3) after an endoscopic mucosal resection (EMR) for a duodenal polyp.

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Diagnosis and Strain Identification of pSS-Related Oral &lt;i&gt;Candida&lt;/i&gt;

Examination of Oral Candida Infection in Primary Sj&#246;gren&#39;s Syndrome Patients

Primary Sj&#246;gren's syndrome (pSS) is an autoimmune disease characterized by symptoms such as dry mouth, dry eyes, and other systematic symptoms. Due to the hyposalivation experienced by pSS patients, oral dysbacteriosis often occurs. A common complication of pSS is the oral Candida infection. In this article, the authors describe systematic methods that can effectively diagnose oral Candida infection and identify the Candida strains using saliva, oral mucosal swabs, or mouthwash from pSS patients. The Sabouraud's Dextrose Agar (SDA), hyphal formation assay, potassium hydroxide (KOH) smear test, and calcofluor white (CFW) staining assay are used for the diagnosis of oral Candida infection. A Candida diagnostic agar is used for the identification of Candida strains. Finally, antifungal susceptibility testing is used to determine appropriate antifungal drug treatment. This standardized method can enhance the diagnosis, treatment, and future research of pSS-related oral Candida infections. Early diagnosis, using this method, can also prevent any complications arising due to delay in receiving appropriate treatment.

Author Spotlight: Oral &lt;i&gt;Candida&lt;/i&gt; Diagnosis to Advance Clinical Treatment Regimen for pSS Patients

Here, we present a protocol for the examination of oral Candida infection in patients with primary Sj&#246;gren's syndrome, which can be used for timely treatment and, thereafter, avoiding related complications.

Primary Sj&#246;gren's syndrome (pSS) is an autoimmune disease characterized by symptoms such as dry mouth, dry eyes, and other systematic symptoms. Due ...