An orchiectomy is a surgical procedure that involves the removal of one or both testicles. This operation is performed for a variety of medical reasons, serving both diagnostic and therapeutic purposes. It is the standard initial approach when testicular cancer is suspected or confirmed, or it may be used to manage advanced prostate or male breast cancer by reducing the body’s primary source of testosterone production. The procedure is also commonly used in trauma cases where a testicle is severely damaged and sometimes as part of gender-affirming care.
Procedure Types and Preoperative Steps
The duration of an orchiectomy is largely determined by the specific type of procedure being performed. The two most common approaches are the Simple orchiectomy and the Radical Inguinal orchiectomy. A Simple orchiectomy is typically performed when the goal is to reduce hormone levels, such as for prostate cancer treatment or feminizing hormone therapy, or for non-malignant conditions. This approach involves making an incision directly in the scrotum to access and remove the testicle.
The Radical Inguinal orchiectomy is the standard method for managing suspected testicular cancer. This procedure requires an incision in the groin area, or inguinal region, rather than the scrotum. The surgeon must remove the testicle along with the entire spermatic cord, which contains blood vessels and lymphatics that could allow cancer cells to spread.
Before the surgeon makes the first incision, several preoperative steps contribute to the total time spent in the operating suite. The patient must first be administered anesthesia, which can be general anesthesia to induce a state of unconsciousness or regional anesthesia with sedation. Next, the surgical team positions the patient correctly on the operating table and prepares the area. This preparation includes scrubbing and sterilizing the skin around the groin and genitalia, followed by draping the area with sterile cloths to minimize the risk of infection.
The Surgical Timeline
The actual surgical timeline, which is the time from the first incision to the final closure, is relatively short for an orchiectomy. A Simple orchiectomy typically requires an operating time of about 30 minutes. This duration is due to the direct scrotal approach and the less complex removal of the testicle without extensive dissection of the spermatic cord.
The Radical Inguinal orchiectomy generally takes slightly longer due to the nature of the dissection required to remove the entire spermatic cord up to the internal inguinal ring. Operating room time for this procedure usually falls within a range of 30 to 60 minutes. The difference in time reflects the necessity of accessing the structures higher in the groin area to ensure all tissue potentially harboring cancer cells is removed.
While the patient may spend a few hours in the hospital, the surgical time itself is brief, making it a common outpatient procedure. Variables such as the patient’s anatomy, whether a testicular prosthesis is placed concurrently, or the need for a bilateral procedure can influence the specific duration. However, the procedure remains a focused operation, and the surgeon’s portion of the work is generally completed within the one-hour mark.
Immediate Post-Surgical Recovery and Discharge
Immediately following the surgery, the patient is transferred to the Post-Anesthesia Care Unit (PACU), also known as the recovery room. This is where the patient wakes up from the effects of the anesthesia, which can take approximately one to three hours. During this period, nurses closely monitor the patient’s heart rate, blood pressure, oxygen saturation, and pain levels to ensure stability.
Before being cleared for discharge, the patient must meet specific criteria designed to ensure a safe transition home. These requirements typically include having stable vital signs, demonstrating adequate pain control with oral medication, and being able to urinate successfully. Since general anesthesia and sedating pain medications are often used, a responsible adult must be present to drive the patient home.
Most orchiectomies are performed on an outpatient basis, meaning the patient does not need an overnight hospital stay. The total time spent in the medical facility, from arrival for preparation to final discharge, is usually between four and eight hours. This timeframe accommodates all the necessary steps, including preoperative preparation, the surgery itself, and the required observation period in the PACU.
Long-Term Recovery Milestones
The first few days of recovery involve rest and managing discomfort at home. Patients typically return to light, non-strenuous daily activities within a few days of the operation. Swelling and bruising in the scrotal area are common and usually subside within the first two to four weeks.
Returning to work is a highly individualized milestone, often depending on the physical demands of the patient’s job. Those with sedentary roles may be able to return within one week, while those with physically demanding occupations may require one to two weeks. Driving is restricted, usually for the first week or two, until the patient is no longer taking prescription pain medication and can comfortably operate the vehicle.
The timeline for resuming strenuous physical activities and heavy lifting is longer to allow for complete internal wound healing. Patients are generally instructed to avoid heavy lifting, defined as anything over 10 to 15 pounds, for four to six weeks. This restriction also applies to vigorous exercise like jogging, cycling, or contact sports. Avoiding strain ensures the incision site and underlying tissues heal fully.