Application

The cord is involved in operations for varicocele, hernia, and castration. In varicocele after the skin incision is made a second incision is required to open the sheath of the cord. This having been done the pampiniform plexus of veins, which are the ones enlarged (varicose) in varicocele, come into view. As many of these as desired are then drawn out, ligated at both ends, and removed. In doing this the spermatic artery may likewise be tied. The circulation is afterwards carried on by the artery and veins of the vas, the cremasteric artery being in the sheath externally. It is wise not to remove all of the enlarged veins. The vas deferens is recognized posteriorly both by sight and touch and is not to be disturbed. In hernia the vas deferens sticks close to the sac, on the posterior and inner side. It must be sought for and carefully isolated. In castration the testicle is so movable that it can be pushed up into the inguinal region and the incision through the skin for its removal made in that locality. If done for malignant disease a large portion of the vas is removed. This can be done by incising up to the internal ring and drawing the vas out after freeing it of any restraining fibrous bands. All bleeding vessels are to be ligated and the cord securely held. If the cord slips before all the vessels are secured, the stump may retract in the abdomen and dangerous bleeding result before it can again be secured and the vessels ligated.