Ex-vivo microscopic oncotesticular sperm extraction: step-by-step surgical technique at time of radical orchiectomy

Christopher K Villota; Sean W Hou; Clark Judge; Scott Eggener; Gladell Paner; Omer A Raheem

doi:10.1016/j.fertnstert.2024.02.037

Ex-vivo microscopic oncotesticular sperm extraction: step-by-step surgical technique at time of radical orchiectomy

Fertil Steril. 2024 Feb 23:S0015-0282(24)00125-0. doi: 10.1016/j.fertnstert.2024.02.037. Online ahead of print.

Authors

Christopher K Villota¹, Sean W Hou², Clark Judge³, Scott Eggener³, Gladell Paner⁴, Omer A Raheem³

Affiliations

¹ Pritzker School of Medicine, University of Chicago, Chicago, Illinois. Electronic address: cvillota@uchicagomedicine.org.
² Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
³ Department of Surgery, Section of Urology, University of Chicago, Chicago, Illinois.
⁴ Department of Pathology, University of Chicago, Chicago, Illinois.

PMID: 38403108
DOI: 10.1016/j.fertnstert.2024.02.037

Abstract

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

Design: Video presentation.

Setting: University Hospital (University of Chicago).

Patients: 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).

Interventions: Left radical orchiectomy and left m-OncoTESE.

Main outcome measures: 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.

Results: 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.

Conclusions: 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.

Keywords: Fertility; fertility preservation; micro-Onco TESE; sperm retrieval; testicular cancer.

Published by Elsevier Inc.