Department of Urology, University of Miami Miller School of Medicine, Miami, Florida.
Department of Urology, University of Miami Miller School of Medicine, Miami, Florida.
Fertil Steril. 2018 Apr;109(4):745. doi: 10.1016/j.fertnstert.2018.01.016.
To demonstrate a step-by-step approach to the use of the operating microscope for onco-testicular sperm extraction.
Video presentation.
University hospital.
PATIENT(S): A 34-year-old man (status post right orchiectomy at another institution for pT3 pure seminoma with negative preoperative tumor markers) was referred for contralateral orchiectomy for multifocal left testis mass and fertility preservation. A postoperative semen analysis for attempted cryopreservation of ejaculated semen identified azoospermia.
INTERVENTION(S): Left radical orchiectomy, left microsurgical onco-testicular sperm extraction (TESE).
MAIN OUTCOME MEASURE(S): Intraoperative technique with commentary highlighting tips for successful fertility preservation via microsurgical onco-TESE. Discussion of alternatives.
RESULT(S): This video provides a step-by-step guide to microsurgical onco-TESE coordinated with radical orchiectomy for testis cancer as a means of fertility preservation in an azoospermic patient. Preoperative imaging with scrotal ultrasound can serve as a useful guide for targeting microdissection to areas of normal testicular parenchyma for extraction of seminiferous tubules likely to host normal spermatogenesis. This patient had successful recovery and cryopreservation of abundant testicular sperm following targeted ex-vivo testicular microdissection.
CONCLUSION(S): Microsurgical onco-TESE may be offered to azoospermic patients when undergoing orchiectomy for testis cancer. Use of preoperative imaging and the surgical microscope guide surgical dissection and optimize sperm recovery.
展示使用手术显微镜进行肿瘤睾丸精子提取的逐步方法。
视频演示。
大学医院。
一名 34 岁男性（在另一机构因 pT3 纯精原细胞瘤行右侧睾丸切除术，术前肿瘤标志物阴性），因左侧睾丸多灶性肿块和生育力保存而被转介行对侧睾丸切除术。试图冷冻保存射出精液的术后精液分析发现无精子症。
左侧根治性睾丸切除术，左侧微创肿瘤睾丸精子提取术（TESE）。
术中技术，伴有评论，突出显示通过微创肿瘤 TESE 进行生育力保存的成功技巧。讨论替代方案。
该视频提供了一个分步指南，用于在睾丸癌根治性睾丸切除术的同时进行微创肿瘤 TESE，作为无精子症患者生育力保存的一种手段。术前阴囊超声成像可以作为靶向微解剖到正常睾丸实质区域以提取可能存在正常精子发生的生精小管的有用指南。该患者在进行靶向体外睾丸微解剖后成功恢复并冷冻保存了大量睾丸精子。
当患者因睾丸癌而行睾丸切除术时，可以向无精子症患者提供微创肿瘤 TESE。术前成像和手术显微镜指导手术解剖，优化精子回收。
