 Good day, everybody. Dr. Sanjay Sanyal, Professor of Department Chair. So this is going to be a demonstration of the spraumatic cord and the testis on the right side. This is a supine cadaver. I'm standing on the right side. The camera person is also on the right side. This cadaver during life had undergone an extensive surgery in the lower part of the abdomen, as a result of which the lower portion of this pelvis and the perineum region was highly fibrosis. And this spraumatic cord was already out of the inguinal canal. This was the location, is the actual location of the spraumatic cord. You can see that it's out here. This is the widely enlarged internal ring, which is an opening in the fascia transversalis. Let's start from inside. We can see this structure entering the internal ring. This is the testicular artery in the testicular vein. And this is the doctor's difference also entering through the internal ring. So having mentioned this, now let's come to the spraumatic cord itself. The spraumatic cord is a composite structure which extends from the upper pole of the testis to the internal ring wire ring. And it contains all the structures either entering into the testis or leaving the testis. Let's take a look at the coverings of the spraumatic cord. The first covering, the deepest covering which comes from transversalis here, is the thin layer. And that is internal spraumatic fascia. This is the internal spraumatic fascia. And this is the one which is derived from the fascia transversalis. The next layer that we see is the cremaster muscle and fascia. And we can see the cremaster muscle fibres here. They are derived from these muscles that we can see in the remnant of the inguinal canal. These are the conjoined muscle, which is the composite fibres of the lower fibres of the internal oblique and the transverse abdominis. And we can see they are giving this extension which is continuing as the cremaster muscle. This also has a fascia that's why it is called cremaster muscle and fascia. This is supplied by the genital branch of genitofemoral nerve and this mediates what is known as the cremaster reflex. Especially in children when the testis is pulled up towards the inguinal canal. The next layer that we can see is derived from the external oblique aponeurosis and we can see it for the lower down. The outermost structure that is this one here. This is the external spraumatic fascia. So to go from outside to inside we have the external spraumatic fascia. Then we have the cremaster muscle and fascia. And we have the innermost that is the internal spraumatic fascia. For the lower down we will see some layers of the testis. But here these are the layers that we can see in this spraumatic cord. Now let's take a look at the contents. This composite structure which I picked up here, this is the testicular artery in the testicular vein. In this region it is not a testicular vein, it is a plexus and that is referred to as a pampliform plexus. And we can see that the pampliform plexus starts from the testis. Initially it contains about 10 to 12 veins and as it progresses up they fuse. They become 8 to 10, 6 to 8, 4 to 6, 2 to 4. And finally when they come into the abdomen they are usually 1 or sometimes 2. And then on the right side the testicular vein drains into the inferior vena keva. On the left side it opens into the left renal vein. The testicular artery starts, we can see from here, it starts from the abdominal aorta and goes down. Apart from that there are few other smaller vessels which are not clearly visible. One of them is the differential artery which supplies the doctor's difference. Which is derived from the inferior vesicle artery. Then we have the cremastric artery which is derived from the inferior epigastric artery. Which runs on the inner surface of the rectus abdominis muscle. The next structure that you can see here is this one, the most important structure of the schematic cord. And we can see the inner portion of that here. This is the doctor's difference. And if you feel it, it is like a tough cord structure. And we are tracing the doctor's difference all the way. And we can see the doctor's difference as it goes down. It starts from the lower end of the epidermis. Here it is the tapering duct of the epidermis. And from here it climbs up on the posterior aspect of the epidermis. And it becomes a doctor's difference. So therefore the course of the doctor's difference is from the lower tail of the epidermis up the testis on the posterior aspect along the schematic cord through the inguinal canal, internal ring, lateral wall of the pelvis behind the bladder in front of the ureter. And then it enters into the prostate urethra as the common ejaculatory duct. The total length of the doctor's difference is 45 cm. Having mentioned all these things, let me come to the testis itself. So this is the testis. And we have completely separated all the structures. Here we can see an additional layer which we did not see up in the schematic cord. And this is this one here. This is the tunica vaginalis. The tunica vaginalis has got two layers. An inner layer which is the visceral layer and the outer layer which is the parietal layer. And in between there's a small amount of fluid. In this particular cadaver there were quite a few calcified concretions. And a few of that is still visible here. This is the place where we can get hydrocele and we can also get hematosele. And when we get hydrocele we cut open the tunica vaginalis and we evert it. And that is one of the surgeries for hydrocele. That's what we have done. This is the testis here. And we can see arising from the upper pole of the testis, this structure here. This is the head of the epididymis. Also called the globus major. And then going above the head and then going behind. This portion is the body of the epididymis. And further lower down it becomes the tail of the epididymis. If you go to look laterally we find a shallow groove between the testis and the epididymis. And that is referred to as the epididymal sinus. When we have done any surgery in the testis and when we had to put it back inside the scrotum we have to make sure that the epididymis is posteriorly and the epididymal sinus is pointing laterally. Otherwise we would produce torsion of the testis. We can see an appendix of the epididymis here, which is an embryonic remnant. And as I've already mentioned, arising from the tail of the epididymis, which is actually the tapering duct of the epididymis, we have this ductus difference arising. This testis is the one which contains 75 estubules and it connects with the epididymis by means of effrin ductules, which bring this epididymis to the epididymis. This is the lower pole of the testis, this is the upper pole of the testis. It is attached, it was attached to the scrotum by means of hyperstructure called the gubernaculum testis. Let's come to the scrotum itself. This particular can ever had a very enlarged scrotum and we have removed all the structures here. This is supposed to contain a smooth muscle which is not clearly visible here called the dartos. And this dartos is under sympathetic control and it is responsible for wrinkling the scrotum's skin, especially in cold weather. Having mentioned all these layers of the testis and the spermatic cord, I need to mention something more. When we are doing any surgery of the spermatic cord of the testis, we usually consider all these layers together. Therefore, when closing this scrotum sac, we usually close the dartos and all the layers of this scrotum together. Now let's come to some clinical correlations pertaining to the spermatic cord. Vasectomy is a commonly performed procedure. It is to be called vasectomy because earlier the dartos difference is to be called vas difference. That's why cutting this is called vasectomy. It is usually done at the root of the scrotum in this region because it is very easily palpable and very superficial. So it is lifted up and this portion is excised and the two ends are then put inside the external spermatic fascia and tied so that they cannot recanalyze. So that is the procedure called vasectomy. We have to be careful not to injure any of the vessels of this pampliform plexus. In this particular cadaver we can see an interesting abnormality. We can see this fatty structure here. This is called the lipoma of the spermatic cord. It is actually an extension of the extreperitoneal fat from the abdomen which pushes into the spermatic cord and this is that lipoma of the spermatic cord. It is a benign condition. We can have a remnant of the processes vaginalis in the cord with the collection of fluid in it and that is known as insisted hydrocele of the cord. It is a variant of the hydrocele which is seen in the testis. If there is a blunt trauma, there can be leakage of blood from the spermatic vessels into the layers of the tunic vaginalis and that condition is known as hematosele. We can get cysts of the epidermis as well as spermatosele. All of them are located in the upper pole. The only way to differentiate them is that the spermatosele will contain milky fluid and cysts of the epidermis will contain clear fluid. These are some of the conditions that are commonly seen in the testis and the spermatic cord. She is making a cut on the tunica albuginia of the right testis. Go a little deep please. Good. Make it deeper. Now she has entered into the testicular tissue. Now we will separate it out. As you can see inside, this is the testicular tissue. This is the testicular tissue. And this is how we do a testicular biopsy. We put it in woven fluid or pigaric acid to test for infertility. That's all for now. Thank you very much for watching. Dr. Sanjay Sanyan signing out. David O is the camera person. If you have any questions or comments, please put them in the comment section below. Have a nice day.