To demonstrate the intraoperative surgical techniques required for simultaneous radical orchiectomy and microscopic oncotesticular sperm extraction (m-OncoTESE) in a step-by-step fashion. Video presentation. University Hospital (University of Chicago). A 37-year-old man (status after right orchiectomy at another institution for stage II-C testicular seminoma with positive preoperative tumor markers) was referred for contralateral orchiectomy of multifocal left testis mass and fertility preservation. Semen analysis before, microscopic testicular sperm extraction during, and semen or testicular specimen analysis after the first orchiectomy were 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., in vitro fertilization or in vitro fertilization-intracytoplasmic sperm injection). Left radical orchiectomy and left m-OncoTESE. A comprehensive visual documentation of m-OncoTESE surgical techniques with concurrent commentary detailing the reasons behind each surgical step. A brief discussion on the background of m-OncoTESE and alternative fertility preservation methods accompanies the procedure. This video provides a step-by-step guide to performing an m-OncoTESE (proceeding a radical orchiectomy in a patient with testicular cancer) as a means of fertility preservation in an azoospermic patient. Successful extraction and cryopreservation of testicular spermatozoa were achieved after targeted ex-vivo testicular microdissection. Sperm extraction via m-OncoTESE is a viable option for azoospermic patients with testicular cancer undergoing radical orchiectomies. The use of preoperative imaging and microsurgical techniques facilitates and optimizes surgical dissection and sperm recovery.

中文翻译：

---

离体显微肿瘤睾丸精子提取：根治性睾丸切除术时的逐步手术技术

逐步演示同步根治性睾丸切除术和显微肿瘤睾丸精子提取 (m-OncoTESE) 所需的术中手术技术。视频演示。大学医院（芝加哥大学）。一名 37 岁男性（因 II-C 期睾丸精原细胞瘤在另一家机构接受右睾丸切除术，且术前肿瘤标志物呈阳性）被转诊接受多灶性左睾丸肿块的对侧睾丸切除术并保留生育能力。术前的精液分析、睾丸精子提取过程中的显微睾丸精子提取以及第一次睾丸切除术后的精液或睾丸标本分析均无法识别出任何精子。对左侧睾丸进行的 m-OncoTESE 术后分析结果冷冻保存了 200,000 个活动精子，用于未来的辅助生殖技术（即体外受精或体外受精-胞浆内单精子注射）。左根治性睾丸切除术和左 m-OncoTESE。 m-OncoTESE 手术技术的全面视觉记录，同时附有详细说明每个手术步骤背后原因的评论。手术过程中还简要讨论了 m-OncoTESE 和替代生育力保存方法的背景。该视频提供了执行 m-OncoTESE（对睾丸癌患者进行根治性睾丸切除术）作为无精症患者生育力保存手段的分步指南。经过针对性的离体睾丸显微切割后，成功提取并冷冻保存睾丸精子。对于接受根治性睾丸切除术的睾丸癌无精症患者来说，通过 m-OncoTESE 提取精子是一种可行的选择。术前成像和显微外科技术的使用促进并优化了手术解剖和精子回收。