This is a good, safe, & reliable method to do a testis sperm extraction in a patient with obstructive azoospermia.
After informed consent, I take the patient to the OR suite. He is given some mild sedation and shaved, prepped, & draped in a sterile fashion. I do an exam with him sedated. I do a cord block with ~8cc of 0.5% marcaine with lidocaine plain. I then hold the skin taught over the testis and infiltrate the scrotal skin with the lido mixture. I then, after I confirmed that he is numb, make a 2cm transverse scrotal incision and deepen it through the scrotum until I exposed the testis in the tunica vaginalis (TV) sack. Hemostasis is obtained with the bovie. I then open the TV to expose the testis and the tunica albuginea (TA). I then place a 5-0 monocryl stitch into the TA at the upper pole of the right testis and tie it. I then make a small longitudinal opening in the TA with a beaver blade. Seminiferous tubules extrude through the opening and these I remove with the scissors and give them to the embryology team. I obtain hemostasis at this point with the bipolar cautery and close the opening in the TA with the previously placed monocryl as a running, interlocking stitch. I then repeat the process several times more until embryology tells me that have sperm in sufficient quantity to freeze, thaw, and use for ICSI, in the case of a patient with obstructive azoospermia. At this point, all the openings in the TA will have been closed as above. I then close the TV with 3-0 vicryl as a running, interlocking hemostatic stitch and close the skin and dartos in 1 layer with a running, interlocking 5-0 monocryl suture. I then clean off the dried prep, place bacitracin ointment on the wound, and fluffs. This ends the procedure.