Single Trocar Skin Puncture Laparoscopic Orchidopexy

Abstract

To assess the outcomes of a modified technique for pediatric laparoscopic orchidopexy performed without instrument trocars. A retrospective cohort study, for all laparoscopic orchidopexy performed without instrument trocars, was performed. Patient demographics, surgical technique, complications, and clinical outcomes were reviewed. All patients undergoing this procedure had a single trocar placed to insufflate and introduce the laparoscope. Skin punctures were used without trocars to introduce 3-mm instrumentation for laparoscopic orchidopexy. Initial follow-up visits were performed 2 to 4 weeks after surgery. Subsequent follow-up visits were performed at 6 to 12 months after surgery to reassess position and size of the testes. A total of 22 patients with 27 undescended testes (20 right, 7 left) were identified. Median age was 1.3 years old (range, 5 months-7 years). Median operative time was 61 minutes (range, 42-81 minutes) for primary unilateral procedures (18 patients). Median operative time was 84 minutes (range, 75-90 minutes) for bilateral procedures (3 patients). All procedures were performed without additional trocars. There were no intraoperative complications. Patients were followed for 1 year and discharged. No patients were lost in follow-up. Postoperatively, 26 of 27 (96%) laparoscopic orchidopexy were successful. One patient developed atrophy with subsequent orchiectomy 6 months after the initial procedure. Using skin punctures without trocars for laparoscopic orchidopexy is a safe and effective modification of standard laparoscopic orchidopexy. Further studies are warranted to compare the morbidity, ergonomics, cosmesis, costs, and reproducibility of outcomes for various options of pediatric minimally invasive surgery for intra-abdominal testes.