OPERATION DATE: 09/05/2019 PREPROCEDURE DIAGNOSIS: Gender dysphoria POSTPROCEDURE DIAGNOSIS: Gender dysphoria PROCEDURE PERFORMED: Bilateral simple orchiectomy SURGEON: Wayne Hellstrom, MD ASSISTANTS: 1. Hoang Minh Tue Nguyen, MD (R) 2. Ayad Yousif, MD (F) 3. Hillary Powers, Medical Student ANESTHESIA: General INDICATIONS FOR PROCEDURE: Ms. Jamie Thompson is a 41-year-old transgender male-to-female with a history of gender dysphoria. She wishes to remove both of her testicles. Risks and benefits of the surgery were discussed with the patient and he agreed to proceed. OPERATION IN DETAIL: The patient was seen in the holding area and examined. The risks and benefits of the procedure were reviewed and all questions were answered. Written informed consent was verified. The patient was then taken to the operating room and placed in a supine position. After smooth uneventful induction of anesthesia, the patient was prepped and draped in the standard surgical fashion. A WHO time-out was performed and all were in agreement. A 3 cm skin incision was made along the median raphe and about 3 cm posterior to the penoscrotal junction. Dissection with Bovie cautery was carried out to the tunica vaginalis of the left testicle. Left testicle, spermatic cord and gubernaculum were identified as well as the vas deferens. Spermatic cord and gubernaculum were divided into two portions and clamped with Kelly. Stick tie with 2-0 Vicryl suture was performed around each half. Then 0 silk ties were utilized to hand tie around the Kelly as well. Incisions were made distal to the clamp Kelly to excise left spermatic cord, testicle and gubernaculum which were passed off the field. Hemostasis was achieved with Bovie cautery. The attention was then turned to the right testicle through the same skin incision. Dissection was carried out with Bovie cautery to the tunica vaginalis of the right testicle. Right testicle, spermatic cord, and gubernaculum were identified as well as the vas deferens. Spermatic cord and gubernaculum were divided into halves and clamped with hemostats. Stick tie with 2-0 Vicryl sutures were performed around each half. 0 silk suture was also utilized to tie off each half. Incision was then made with the Bovie cautery distal to the clamp Kelly to excise right spermatic cord, testicle and gubernaculum which were passed off the field. Hemostasis was achieved with Bovie cautery. Dartos layer was then closed with interrupted 2-0 Vicryl sutures in two layers. Skin incision was closed with interrupted 4-0 Monocryl in a vertical mattress fashion. The patient was then extubated, awakened, and transferred to PACU with no untoward events. The patient tolerated the procedure well and without complication. Sponge, needle, and instrument counts were correct at the end of the case. Dr. Hellstrom was present and scrubbed throughout the procedure. DISPOSITION: The patient will be observed in PACU until alert and awake and to be discharged home this afternoon. There was no complication during the surgery. ESTIMATED BLOOD LOSS: 5 mL. SPECIMENS: Bilateral testicles.