Laparoscopic staged spermatic vessel-sparing procedure for intra-abdominal undescended testis

Abstract

The aim of this report is to present our initial experience with a new laparoscopic surgical technique for elongation of the spermatic vessels and orchidopexy for intra-abdominal undescended testis. We performed surgical elongation and orchidopexy in three patients with intra-abdominal undescended testis. Under direct laparoscopic vision, a non-absorbable suture was placed through the lower pole of the intra-abdominal undescended testicle. Using a Maryland grasper, the suture was brought through the inguinal channel all the way down to the scrotal skin. We took out the suture and performed progressive traction on the suture mobilizing the testicle downward without putting the spermatic vessels on appropriate maximum tension. The second stage was performed after a period of 3–6 months when we checked the elongation of the spermatic vessels. In two patients, the degree of elongation was enough so that scrotal orchidopexy was possible immediately. In one patient, an intermediate step of further traction and elongation was necessary. The definitive orchidopexy was possible 6 months later. We had no intraoperative incidents and no postoperative complications. In all three patients, we succeeded to mobilize and fix the undescended testicle in its scrotal, normal position. No signs of postoperative ischemia or testicle atrophy were noticed. This surgical technique seems to be a viable alternative to current procedures for intra-abdominal undescended testis. The procedure is safe and effective, all the natural testicular vascular supply is preserved and during the intermediate position the testicle is placed closer to its natural location.