Once the spermatic cord has been exposed within the inguinal canal, its most superficial layer, the cremaster muscle, is removed. This is achieved by incising gently along the line of the cord to produce two flaps, superolateral and inferomedial. These are dissected away from the cord back to the deep ring and pubic tubercle respectively.
The two flaps of cremaster are clamped, twisted, ligated and divided to expose underlying cord structures e.g. pampiniform plexus, vas deferens and possibly indirect hernial sac.
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