Ex-Vivo Microscopic Onco-Testicular Sperm Extraction: Step-by-Step Surgical Technique at Time of Radical Orchiectomy.

OBJECTIVE: To demonstrate the intraoperative surgical techniques required for a simultaneous radical orchiectomy and microscopic onco-testicular sperm extraction (m-OncoTESE) in step- by-step fashion.

DESIGN: Video presentation.

SETTING: University hospital (University of Chicago).

PATIENT(S): A 37-year-old male (status post right orchiectomy at another institution for stage II-C testicular seminoma with positive preoperative tumor markers) was referred for contralateral orchiectomy for multifocal left testis mass and fertility preservation. Semen analysis prior, microTESE during, and semen/testicular specimen analysis post the first orchiectomy, was unable to identify any sperm. A postoperative analysis of the m-OncoTESE performed on the left testis resulted in the cryopreservation of 200,000 motile sperm for future assisted reproductive technology (i.e. IVF or IVF-ICSI).

INTERVENTION(S): Left radical orchiectomy, left microscopic onco-testicular sperm extraction.

MAIN OUTCOME MEASURE(S): A comprehensive visual documentation of m-OncoTESE surgical techniques, with concurrent commentary detailing the reasoning behind each surgical step. A brief discussion on the background of m-OncoTESE and alternative fertility preservation methods accompanies the procedure.

RESULT(S): This video provides a step-by step guide for performing a m-OncoTESE (proceeding a radical orchiectomy in a testicular cancer patient) as a means of fertility preservation in an azoospermic patient. Successful extraction and cryopreservation of testicular spermatozoa was achieved post-targeted ex-vivo testicular microdissection.

CONCLUSION(S): Sperm extraction via m-OncoTESE is a viable option for azoospermic testicular cancer patients undergoing radical orchiectomies. The use of preoperative imaging and microsurgical techniques facilitate and optimize surgical dissection and sperm recovery.