Laparoscopic Orchiopexy for Palpable Undescended Testes: A Five-Year Experience

Abstract

Most recent reports of laparoscopic orchiopexy concern nonpalpable testes. We report the results of this approach in patients with undescended palpable testes. Between January 1999 and September 2004, 28 patients with 30 undescended palpable testes were treated by laparoscopic orchiopexy performed by the same surgeon. Patients with palpable cryptorchidism were included. Patients with nonpalpable testes, retractable, or vanishing testes were excluded. The mean age of the patients was 25 months (range, 8 months-5 years) and the mean weight was 16 kg (range, 8-24 kg). We used a 4-port technique (one 10-mm, two 2-3 mm, and one 5-mm), a 4-mm scope, and 2-3 mm instruments. The mean operative time was 50 minutes. The complication rate was 13.3% (4/28), all in the first two years, at the beginning of the learning curve. The remaining testes were descended by laparoscopy; 5 (16.6%) were peeping testes. We had 10 (33.3%) left and 16 (53.3%) right palpable cryptorchidia cases, plus 4 testes (13.3%) that were bilateral undescended and palpable. No hernia was found in 8 (28.6%) cases; a homolateral hernia was found in 18 (64.3%) cases, and we did not close the processus vaginalis, we only resected the membranes. We found 2 (7.1%) with contralateral hernia in which we did close the processus vaginalis. On follow-up ranging 5 months-5 years, 29 of these testes maintain good size and a correct position, with no recurrent inguinal hernia. The laparoscopic approach is a safe way to descend the palpable testicle. Although this is not a large series, it shows that laparoscopic orchiopexy of palpable undescended testes can be done without a higher complication rate than the open procedure (13.3% vs. 12.2%), with several of the advantages of the laparoscopic approach.