A modified technique of laparoscopic mobilisation and transfer of intra-abdominal testis via inguinal canal.

Abstract

Several techniques have been described for mobilising intra-abdominal testis (IAT) into the scrotum. Many are associated with significant morbidity. We hereby introduce our modification of the technique that is safe and reproducible. Surgical technique using a nylon tape to railroad instruments into the peritoneal cavity to minimise false passage and trauma is described in detail. Once the testis is delivered out of the scrotal wound, further division of restrictive bands to mobilise the testis is carried out laparoscopically. These steps are not previously described in the literature. A retrospective study of consecutive patients with IAT undergoing surgical intervention by a single surgeon over a period of 15 years has been included to demonstrate outcome. Twenty-five patients with unilateral IAT (10R, 15L) and 2 patients with bilateral IAT, a total of 29 IAT, underwent laparoscopic orchidopexy over the period 1997-2012. Median age of the patients was 3.0 years. One-stage testicular vessel preserving (VP) orchidopexy was performed in 20 testes, Fowler-Stephen (FS), vessel sacrificing orchidopexy (3 one-stage and 6 two-stage) was required in 9 testes. At follow-up, atrophy was detected in 1 (5.0 %) and 2 (22.2 %) patients of the VP and FS groups respectively. The railroading technique of transferring IAT into the scrotum via the inguinal canal under laparoscopic guidance minimises tissue trauma. It negates the need to create new tissue opening. It is reproducible with a testicular atrophy rate comparable to published literature.