OT notes · Urology

Orchidopexy

Usual anaesthesia
General, with caudal block or local nerve block for pain relief
Position
Supine (slight Trendelenburg for laparoscopy)
Setting
elective

Operative note template for orchidopexy for an undescended testis (inguinal, scrotal or laparoscopic), with a filled example for a right open inguinal orchidopexy in a 14-month-old boy.

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Blank template

Follow this order in the case sheet. Tick the options that apply and fill the blanks.

Patient and case

  1. Name / Age / Sex
  2. UHID / IP no. / Ward-Bed
  3. Date of surgery / OT no.
  4. CaseElectiveEmergency (non-elective)if emergency, state urgency and reason
  5. Timesin OT ___ anaesthesia start ___ incision ___ closure ___ out of OT ___

Team

  1. Operating surgeonname, designation
  2. Assistant(s)
  3. Supervising consultantpresent in OT / available / not applicable
  4. Steps done by the residentwhole procedure / named steps, under whose supervision
  5. Anaesthetist
  6. Scrub nurse / circulating nurse

Diagnosis and procedure

  1. Pre-operative diagnosis
  2. Post-operative diagnosis
  3. Procedure planned
  4. Procedure performedif different from plan, state why
  5. Extra procedure done and reason'none' if none. Only to save life or health if not consented

Consent and safety checks

  1. Informed consentGeneralProcedure-specificHigh-riskAnaesthesiain a language the patient understands: language ___ witness ___
  2. Site / side markedYesNot applicable
  3. WHO Surgical Safety ChecklistSign inTime outSign out
  4. Antibiotic prophylaxisdrug, dose, route, time given before incision
  5. VTE prophylaxisMechanicalPharmacologicalNot indicated

Risks to explain in the consent for this operation

  • testis may shrink (atrophy)
  • testis may pull back up and need a second operation
  • bleeding or scrotal haematoma
  • wound infection
  • injury to the vas or ilioinguinal nerve
  • testis may be absent or not viable and need removal
  • a second (staged) operation for a high testis
  • fertility and cancer risk of an undescended testis are not fully removed by surgery

Pre-operative details for this operation

  1. SideRightLeftBilateral
  2. Examination before surgeryPalpable high scrotalPalpable inguinal (canalicular)Palpable at / beyond external ring (ectopic)Non-palpable
  3. Opposite testisposition and size
  4. Age at surgerymonths
  5. Bilateral non-palpable testesNot applicableEvaluated for disorder of sex development: result
  6. Previous groin or scrotal surgeryNoneHernia repair / previous orchidopexy (redo)

Anaesthesia and position

  1. AnaesthesiaGeneral + caudal blockGeneral + local nerve block by surgeonGeneral
  2. Examination under anaesthesiatestis position once relaxed; may change the plan
  3. PositionSupineSupine, Trendelenburg 30 degrees (laparoscopy)
  4. Bladder emptied / catheterfor laparoscopy, to avoid bladder injury

Operative findings

  1. Position of testis at surgerySuperficial inguinal pouchIn canalAt internal ring (peeping)Intra-abdominalAbsent: blind-ending vesselsNubbin / vanished testis
  2. Testissize (compare with opposite), consistency, appearance
  3. Epididymis and vasnormal / long looping vas / separation from testis
  4. Processus vaginalisPatent (hernia sac)Closed
  5. Cord lengthreaches scrotum without tension / needed retroperitoneal mobilisation

Procedure (steps)

  1. ApproachInguinalScrotal (single incision)Laparoscopic single-stageLaparoscopic Fowler-Stephens stage 1 (vessels clipped)Fowler-Stephens stage 2
  2. Incisionsite and length
  3. External oblique opened, ilioinguinal nerve protectedYesNot applicable
  4. Testis freedgubernaculum divided, cremasteric fibres stripped
  5. Tunica vaginalis opened; appendix testis / epididymisRemovedNot present
  6. Processus vaginalis / hernia sacseparated from vas and vessels and ligated high at internal ring; suture used
  7. Extra cord lengthNot neededRetroperitoneal mobilisationPrentiss manoeuvre (under inferior epigastric vessels)
  8. Subdartos pouchscrotal incision (length); pouch made between skin and dartos
  9. Testis brought downno twist of cord; orientation checked
  10. FixationSubdartos pouch, neck narrowedTunica fixed to dartos with absorbable sutureDartos closed behind testis
  11. Final positionDependent scrotalHigh scrotalCould not reach scrotum: plan

Closure, drains and dressing

  1. Internal oblique / external obliquesuture; new external ring not too tight
  2. Scarpa fascia / subcutaneoussuture
  3. Skin (groin and scrotum)absorbable subcuticular suture size; skin adhesive
  4. Local anaestheticdrug, strength, volume, or caudal given by anaesthetist

Specimens and implants

  1. Hernia sac / appendix testisDiscardedSent for HPE
  2. Testicular nubbin or removed testisSent for HPENot applicable

End of procedure

  1. Estimated blood lossml
  2. IV fluids and blood / products givenfluids (ml); blood: type, units, bag nos.
  3. Swab, needle and instrument countCorrectIncorrect: action taken
  4. Intra-operative complications / difficultieswhat happened and what was done; 'none' if none
  5. Implant stickersNo implantAffixed in case sheet, OT register and for discharge summary
  6. Condition at end of surgery / shifted toPACUWardICU/HDU

Post-operative orders

  1. Feedsresume when awake
  2. Analgesiadrug and dose by weight
  3. Scrotal swellingmild swelling is usual; rapidly growing swelling needs review
  4. Activityno straddle toys, cycling or sports for 4 weeks
  5. Dischargeday care or next morning
  6. Follow-upwound check; examine testis position and size at follow-up visits
  7. Stage 2 date (Fowler-Stephens)about 6 months after stage 1

Signature

  1. Name and designation of person writing note
  2. Medical Council registration no.
  3. Signature / date / time of writingwrite before the patient leaves recovery

Worked example

Fictional case: Master K.S., 14 months, 11 kg, right testis palpable in the inguinal canal since birth, left testis normal in the scrotum.

Case details

Date: 18/08/2026. Elective right inguinal orchidopexy. Paediatric OT.

In OT 09:00. GA 09:05. Caudal 09:10. Incision 09:20. Closure completed 10:05.

Surgeon: Dr A. (2nd-year resident, Paediatric Surgery). Assistant: Dr B. Consultant: Dr C., scrubbed.

Anaesthetist: Dr D. Scrub nurse: Sr E.

Indication and pre-op

Right undescended testis, palpable in the canal, cannot be brought into the scrotum. Left testis normal size, in scrotum.

Consent: procedure-specific and anaesthesia consent taken from both parents in Marathi, including atrophy, re-ascent and need for removal if non-viable. Right side marked.

WHO checklist done. Inj cefazolin 330 mg IV (30 mg/kg) at 09:12, before incision.

Anaesthesia and position

General anaesthesia. Caudal block given by anaesthetist. Supine.

Examination under anaesthesia: right testis in the canal, not reaching the scrotum. Groin and scrotum painted with povidone-iodine and draped.

Procedure

Right groin skin-crease incision 2.5 cm. External oblique opened through the external ring. Ilioinguinal nerve seen and protected.

Findings: testis in the canal, about 1.2 x 0.8 cm, slightly smaller than the left, normal appearance. Epididymis and vas normal. Processus vaginalis patent.

Cremasteric fibres stripped and gubernacular attachments divided. Tunica vaginalis opened; appendix testis removed.

Processus vaginalis separated from vas and vessels at the internal ring, twisted and transfixed with polyglactin 910 (Vicryl) 4-0.

Cord length adequate after release of lateral spermatic fascia; no retroperitoneal dissection needed.

Right scrotal transverse incision 1.5 cm. Subdartos pouch made. Testis brought down through the dartos with a clamp on the gubernaculum, cord not twisted. Tunica fixed to dartos above and below with fine absorbable sutures. Testis lies in dependent scrotal position without tension.

Closure

External oblique closed with interrupted Vicryl 3-0, new external ring not tight. Scarpa fascia with Vicryl 4-0.

Groin and scrotal skin closed with subcuticular absorbable 5-0. Skin adhesive applied.

Specimens and implants

Appendix testis and sac remnant discarded as anatomical waste. No specimen sent. No implant.

End of procedure

Blood loss minimal, about 5 ml.

Mop, needle and instrument count correct.

No intra-operative complications.

Shifted to recovery. Heart rate 118/min, SpO2 99%.

Post-op orders

Feeds when fully awake.

Oral paracetamol by weight as per paediatric protocol.

Watch the scrotum for rapidly increasing swelling.

Discharge same evening if feeding and passing urine.

No straddle toys for 4 weeks. Wound check at 1 week; testis position and size at 3 months.

Signature

Dr A., JR-2, Paediatric Surgery. Reg. no. ________. 18/08/2026, 10:20.

Must document for this operation

  • Position of the testis before and at surgery, and its size compared with the other side. Outcome and later atrophy are judged against this baseline.
  • Whether the processus vaginalis was patent and how it was ligated. An unligated sac can lead to a hernia or hydrocele later.
  • Final position of the testis (dependent scrotal or high) and whether it lay without tension. A testis left high or under tension is at risk of re-ascent, and the next surgeon needs to know.
  • Any extra step for length (retroperitoneal mobilisation, Prentiss manoeuvre, vessel clipping). This changes the blood supply and the approach at any redo or second stage.
  • Findings in a non-palpable testis: absent, blind-ending vessels, nubbin, or intra-abdominal. Blind-ending vessels end the search; a blind-ending vas alone does not, so the note must say which.
  • Stage and plan in Fowler-Stephens surgery. Stage 2 is done months later, often by a different surgeon.

Common mistakes in these notes

  • Writing 'orchidopexy done' without the final testis position.
  • Not recording testis size, so atrophy cannot be judged later.
  • Leaving out whether the hernia sac was found and ligated.
  • For a non-palpable testis, writing 'testis absent' without saying whether blind-ending vessels were seen.
  • Giving an adult antibiotic dose in a child instead of a weight-based dose.

Indian practice and paperwork

  • Tissue removed and not sent for HPE (hernia sac, appendix testis) is human anatomical waste for the yellow bag. Discarded formalin is yellow (f) chemical waste. (Bio-Medical Waste Management Rules 2016, CPCB guidelines)
  • Consent must explain the procedure, risks, benefits and alternatives in a language the parents understand, and is taken by the person doing the procedure. (NABH 5th ed., PRE.4(c) and (e))

Sources

  • Smith JA Jr, Howards SS, Preminger GM, Dmochowski RR, eds. Hinman's Atlas of Urologic Surgery. 5th ed. Elsevier; 2026, Ch 114, Undescended Testis (Corbett, Timberlake), pp. 892-899.
  • Smith JA Jr, Howards SS, Preminger GM, eds. Glenn's Urologic Surgery. 8th ed. Wolters Kluwer; 2016, Ch 101, Pediatric Cryptorchidism, Hydroceles, and Hernias, e-book PDF pp. 1372-1389.
  • Bratzler DW, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283. Table 1: cefazolin paediatric 30 mg/kg IV (adult 2 g), within 60 min before incision. Table 2, urologic, clean without entry into urinary tract: cefazolin. academic.oup.com/ajhp/article/70/3/195/5112717

Educational template for residents. Adapt it to your institution's case-sheet format and your consultant's instructions. Patient details in the example are fictional.

Videos of this operation

Teaching videos and pages for this operation, listed under the curriculum item that asks for it.

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