Chevassu maneuvre
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"Chevassu manoeuvre" OR "Chevassu maneuver" surgical procedure
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Chevassu maneuver testicular tumor inguinal exploration
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Chevassu Manoeuvre
The Chevassu manoeuvre is a urological surgical technique used during inguinal exploration of a suspected testicular tumor, particularly when the diagnosis is uncertain and testis-sparing is being considered. It was first described by Maurice Chevassu in 1906.
Background and Rationale
When a testicular mass is suspected to be malignant, the standard approach is radical inguinal orchiectomy - the testis is never explored or biopsied via a scrotal incision. This is because a scrotal approach can disrupt the lymphatic drainage of the testis (which follows the internal iliac/para-aortic nodes), spreading tumor cells to the inguinal and pelvic nodes instead - fundamentally altering staging and treatment.
However, up to 50% of inguinal explorations for intrascrotal masses result in orchiectomy for what turns out to be benign disease (hydrocele, epididymitis, benign testicular tumors). The Chevassu manoeuvre was devised to allow safe biopsy and intraoperative assessment without risking tumor seeding.
Indication
- Small intrascrotal / testicular mass
- Unlikely to be cancer clinically
- Goal is to confirm or exclude malignancy before committing to radical orchiectomy
- Especially useful in a solitary testis or bilateral tumors where organ preservation is critical
Technique (Step by Step)
- Inguinal incision - an incision is made in the inguinal (groin) region, not the scrotum.
- Delivery of the testis - the testis is delivered into the operative field through the inguinal wound.
- Vascular occlusion (key step) - the spermatic cord vessels are cross-clamped (occluded) at the internal inguinal ring before any manipulation of the testis. This prevents potential hematogenous spread of tumor cells during handling. Some modifications add scrotal hypothermia to protect the testis from ischemia during clamping.
- Opening the tunics - the tunica vaginalis (and if needed, the tunica albuginea) is opened.
- Excisional biopsy / frozen section - the tumor is excised and sent immediately for intraoperative frozen section analysis, which gives a diagnosis within ~30 minutes.
- Decision based on result:
- Benign - the tunica is repaired, the testis is replaced, and the wound is closed. The testis is preserved.
- Malignant - radical orchiectomy is completed (testis + spermatic cord to the level of the internal ring).
Some groups add double ligation of the gubernaculum before its division, and irrigation with distilled water (hypotonic lysis of any shed tumor cells) as additional precautions.
Why the Inguinal Route is Mandatory
Scrotal biopsy is absolutely contraindicated because:
- The testis drains lymphatically to para-aortic nodes (T10-L1 level)
- A scrotal incision redirects lymphatic drainage to inguinal nodes, upstaging and complicating treatment
- Risk of local recurrence in the scrotal skin and inguinal nodes
Clinical Significance
The manoeuvre allows organ-sparing in cases of benign disease that might otherwise result in unnecessary orchiectomy. In the original series by Goldstein & Waterhouse (1983), 3 out of 5 patients explored using this technique had benign disease and their testis was preserved without subsequent atrophy.
Summary Table
| Feature | Detail |
|---|---|
| Described by | Chevassu, 1906 |
| Context | Testicular tumor - uncertain diagnosis |
| Incision | Inguinal (never scrotal) |
| Key step | Spermatic cord vessel clamping before biopsy |
| Purpose | Prevent tumor seeding during frozen section biopsy |
| Outcome if benign | Testis preserved |
| Outcome if malignant | Radical orchiectomy completed |
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