Background

Gonadectomy is surgical procedure to remove gonads that produce eggs or sperm.

This procedure stops sex hormone production and causes sterility.

Castration has been performed for social, religious, or punitive reasons historically.

Gonadectomy suitable for intersex children and teenagers.

Laparoscopic gonadectomy is safe and effective for children and teenagers.

It eliminates risks of pregnancies, pyometra, and ovarian or uterine tumors.

Gonadectomy in males reduces perianal adenomas, benign prostatic hyperplasia, and certain sexually dimorphic behaviors.

Detailed risk profiles for post-gonadectomy weight gain aid veterinarians and owners in optimizing surgery timing and husbandry practices.

Establishing baseline risk of weight gain from sterilization aids evaluation of nonsurgical alternatives.

Effects of Gonadectomy as follows:

In Males:

Loss of muscle mass

Osteoporosis

Loss of libido

Mood changes

In Females:

Early menopause

Osteoporosis

Increased cardiovascular risk

Mood disturbances

Indications

For Males (Orchiectomy):

Testicular Cancer

Prostate Cancer

Severe Trauma or Infection

For Females (Oophorectomy):

Ovarian Cancer

Severe Endometriosis

Ovarian Cysts

Severe Pelvic Inflammatory Disease

Contraindications

Uncontrolled bleeding disorder

Severe cardiopulmonary instability

Active severe infection (sepsis)

Severe psychiatric disorder without capacity for consent

Poorly controlled diabetes

Obesity

History of extensive abdominal surgery

Severe osteoporosis (in oophorectomy)

Desire for future fertility

Outcomes

Gonadectomy outcomes depend on the procedure’s reason, patient health, and post-surgery use of hormone replacement therapy (HRT).

Gonadectomy enhances gender dysphoria, body satisfaction, and psychological well-being for many individuals.

It reduces ovarian cancer risk but slightly increases some non-reproductive cancers.

Equipment required

Incision Instruments

Dissection & Grasping  Tissue forceps

Retractors  Senn retractors

Laparoscope

Trocars

Graspers

Scissors

Energy Devic

Suction/Irrigation

Specimen Bag

Suture Materials

Electrosurgical Unit

Patient Preparation:

Patient assessment including medical history, medication review, and psychosocial and fertility counseling.

Hormonal therapies require adjustments for patients. Hormone therapy may pause before surgery per surgical team protocol.

Informed Consent:

Explain the procedure’s risks and potential complications clearly to the patient.

Patient Positioning:

Patients should be positioned in supine positions. General anesthesia is used.

Make sterile preparation of groin and scrotal area.

Figure 1. Surgery of genital organs

Figure 2. Reproductive organs

Technique

For Inguinal Orchiectomy:

Step 1: Incision

A small oblique shape incision is made over the inguinal canal.

Step 2: Identification of Spermatic Cord

The spermatic cord is isolated and ligated to prevent tumor spreading in cancer cases.

Step 3: Delivery of Testicle

Then testicles are mobilized and gently pulled out through the inguinal incision.

Avoid direct scrotal incision in suspected cancer cases to avoid seeding tumor cells.

Step 4: Ligation and Removal

The cord structures are double ligated with absorbable or non-absorbable sutures. Finally, testicles and cords are removed en bloc.

Step 5: Closure

At last layered closure of fascia, subcutaneous tissue, and skin.

For Laparoscopic Oophorectomy:

Step 1: Trocar Placement

Usually, 3 to 4 ports are required. For lower quadrants for working ports.

Step 2: Identification of Ovary

Ovary is visualized and gently mobilized. Then adjacent structures are identified to avoid injury.

Step 3: Ligation of Ovarian Pedicle

Blood supply is sealed and divided.

Step 4: Removal of Ovary

The ovary is detached from the fallopian tube and uterine attachments.

Then specimen is removed through an endobag to prevent spillage.

Step 5: Closure

Port sites are closed in layers.

Complications:

Bleeding

Injury to Adjacent Structures

Scrotal Hematoma

Vascular Compromise

Thromboembolism

Wound Dehiscence

Chronic Pain

Lymphocele

Incisional Hernia

Hormonal Deficiency Syndrome

Osteoporosis

Cardiovascular Disease

Sexual Dysfunction

Weight Gain & Metabolic Changes

References

Laparoscopic approach for gonadectomy in pediatric patients with intersex disorders – PMC

Challenges in laparoscopic gonadectomy for complete androgen insensitivity syndrome with nonpalpable inguinal glands – PMC

References

Laparoscopic approach for gonadectomy in pediatric patients with intersex disorders – PMC

Challenges in laparoscopic gonadectomy for complete androgen insensitivity syndrome with nonpalpable inguinal glands – PMC