- Incision and exposure
- Midline or transverse scrotal incision on affected side
- Transverse incision preferred for cosmesis and access
- Dissect through dartos, external spermatic fascia, cremasteric fascia, internal spermatic fascia expose the testis and epididymis
- Cyst identification and dissection
- Gently deliver testis and epididymis into the wound
- Identify the cyst, usually attached to head of epididymis
- Carefully dissect cyst from surrounding epididymal tissue using fine scissors or bipolar cautery
- Avoid injury to vas deferens or testicular vessels
- Haemostasis and closure
- Ensure meticulous haemostasis
- If large defect remains, leave open or consider small suture repair
- Replace testis into scrotum
- Close dartos and skin in layers, typically with absorbable sutures