Single Setting Bilateral Laparoscopic Orchiopexy for Bilateral Intra-Abdominal Testicles

Abstract

The laparoscopic surgical approach to unilateral intra-abdominal testis has replaced the open approach at several large centers. There is considerable literature on experience with unilateral intra-abdominal testes but little on the management of bilateral intra-abdominal testes. We assessed the feasibility and safety of performing single setting bilateral laparoscopic orchiopexy in boys with bilateral intra-abdominal testes. A single surgeon experience was reviewed. The surgical technique was similar in all cases and on each side, including infra-umbilical access, diagnostic evaluation, peritoneal mobilization lateral to the spermatic vessels and inferior to the vas deferens, gubernacular transection, and a decision for or against a Fowler-Stephens procedure and testis relocation into the scrotum with fixation. Followup consisted of physical examination 14 days, 6 months and 1 year postoperatively, when testicular position and size were assessed. Intraoperative and postoperative complications were noted. Single setting bilateral laparoscopic orchiopexy was attempted in a total of 42 testes in 21 boys with a median age of 9 months (range 7 to 52). It was completed in a total of 36 testes in 18 boys. All procedures were performed on an outpatient basis. Of the 42 testes orchiopexy was performed in 4 with Fowler-Stephens ligation, including at a 1 and 2-stage procedure in 2 each. Although the latter 2 cases account for 2 of the 3 not completed at a single setting, excellent outcomes were achieved in these cases at the second setting, yielding bilateral intrascrotal testes in each. A third boy required a subsequent open procedure for relocation of a testis from an inferior pubic/superior scrotal position to a more dependent portion of the scrotum. Testicular position after laparoscopy was the mid lower scrotum in 38 cases, upper scrotum in 3 and inferior pubic/superior scrotal in 1. Atrophy was noted in 2 of the 42 testes (19 of 21 boys) at 6-month followup, including in 1 boy who underwent a 1-stage Fowler-Stephens procedure and 1 who underwent nonFowler-Stephens orchiopexy. Of the 21 boys 16 required only 1 surgery to achieve viable intrascrotal testes at 1-year followup. Of the 21 boys 19 (91%) ultimately achieved bilateral viable intrascrotal testes. There was no correlation between patient age and the likelihood of success or failure. No patient experienced any complications or hospital admissions. In boys with bilateral intra-abdominal testes single setting bilateral laparoscopic orchiopexy can be performed safely on an outpatient basis with a high degree of success. Most boys undergo a single surgery with the testes relocated to a satisfactory intrascrotal position without atrophy.