Two-Stage Laparoscopic Orchidopexy with Gubernacular Preservation: Preliminary Report of a New Approach to the Intra-Abdominal Testis

Abstract

Laparoscopic management of the intra-abdominal testis (IAT) typically involves division of the gubernaculum and passage of the mobilized IAT into the scrotum through the floor of the inguinal canal. However, this approach transects potentially vital gubernacular collaterals and may predispose patients to future direct inguinal hernias. We therefore present our experience with a modified two-stage laparoscopic orchidopexy (TSLO) with gubernacular preservation. The TSLO involved an initial testicular vessel transection 2–3 cm proximal to the testis. A few months later, the testis was mobilized laparoscopically with an adjacent peritoneal flap preserving collaterals between the vas and the testicular hilum. Gubernacular collaterals were preserved and the testis delivered through the internal ring and inguinal canal via a standard inguinal incision. Fourteen patients (with 17 IAT) underwent first stage testicular vessel ligation. Thirteen patients (mean age, 2.9 years) with 15 IAT have completed TSLO (mean, 6.5 months after first procedure). Of these 15 TSLO with mean followup of 6 months, 14 were found in the scrotum. One was found at the external ring. By palpation, all testes were viable. TSLO with gubernacular preservation is a reliable means with which to bring an IAT into the scrotum.