. Manual of operative surgery. Step 6.—Close the wound in layers. Epididymectomy.—This operation may be done alone or vasectomy may be added to it. Step I.—Make an incision into the tunica vaginalis, just external and parallel to the epididymis. If the epididymis is adherent to the skin or fistulae are present, such adherent skin and fistulae should be surrounded by elliptical incisions and removed with the epididymis. Step 2.—Make an incision along the junction between the epididymisand testicle on the outer side. This incision divides the serous membranealone opposite the body of the epididy
. Manual of operative surgery. Step 6.—Close the wound in layers. Epididymectomy.—This operation may be done alone or vasectomy may be added to it. Step I.—Make an incision into the tunica vaginalis, just external and parallel to the epididymis. If the epididymis is adherent to the skin or fistulae are present, such adherent skin and fistulae should be surrounded by elliptical incisions and removed with the epididymis. Step 2.—Make an incision along the junction between the epididymisand testicle on the outer side. This incision divides the serous membranealone opposite the body of the epididymis, while at the head and tail (globusmajor and minor) it divides the tunica albuginea. With knife or scissorsseparate the head (globus major) from the testicle. Next separate the bodyof the epididymis from the testicle (Fig. 908). As the inner side of the junctionbetween the epididymis and testicle is reached, proceed with great care, be-cause here the vessels going to the testicle are in contact with the Fig. g o 8 . — Epidid\mectomy.{Monod and Vanverts.) ANASTOMOSIS VAS DEFERENS 743 By making slight traction and putting the structures of the cord gently onthe stretch, it becomes easy to separate the epididymis from the vessels. Step 3.—The epididymis being free, continue the dissection by separatingthe vas from its surroundings up to the internal ring, where it is grasped onboth sides of its circumference with hemostatic forceps, divided, and the lumenof the proximal end cauterized with 95 per cent, carbolic acid on the end ofa needle. The needle is to be worked upwards in the lumen for y^o. i^^chand the mucous membrane thoroughly cauterized. Ligate the proximal endof the vas. This is important in that it prevents infectious material beingvoided from the vas into the tissues. Step 4.—Review the wound made in the testicle by the removal of theepididymis. If any foci of disease are found, excise them by wedge-shapedincisions and close the wounds wit
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