Laparoscopic Orchidopexy Research Articles

Surgical and Morphological Outcome of One Stage Laparoscopic Orchidopexy with Preservation of Gubernaculum and Interruption of Spermatic Vessels in Comparison to Two Stages Fowler–Stephens’s Orchidopexy Technique with Preservation of Gubernaculum for Impalpable Testis

Abstract Introduction Laparoscopy has attained full acceptance, both diagnostically and therapeutically for the management of non-palpable testis. Conventional laparoscopic Fowler-Stephens’s orchidopexy is a common accepted technique for cases where spermatic vessels` length can preclude tension-free testicular mobilization in the scrotum. Gubernaculum sparing with cutting of testicular vessels has an important role to keep a good vascularity of the testis. Our study suggests performing F-S technique with preservation of the gubernaculums in one stage instead of two stages with the same final results. Patients and Methods This was a Randomized controlled clinical trial (RCT), conducted on Boys with Non-palpable testicle between 1 year to 6 years old, in 2 Egyptian pediatric surgery units, between October 2019 and September 2022.The patients met our inclusion criteria were divided into 2 groups to compare their outcome (atrophy and success rate): ( Group A with 25 impalpable testicle were subjected to one-stage laparoscopic assisted orchidopexy with interruption of spermatic vessels and preservation of the gubernaculums, while Group B with 25 impalpable testicle were subjected to two-stages laparoscopic assisted orchidopexy with interruption of spermatic vessels and preservation of the gubernaculums). Results The mean age of all patients were (3.9 ± 1.8), 113 non-palpable testicle were examined during the period of our study, 50 non-palpable tesicle were met our inclusion criteria. They were divided into 2 groups according to surgical procedure. There were no significant differences between the 2 groups according to age, preoperative testicular volume. Post operative outcome (atrophy and success rate) had no significant differences. Operative time and hospital stay were statistically decreased in the group performed with one stage. Conclusion One-stage laparoscopic orchidopexy with preservation of gubernaculum and ligation of testicular vessels to be as effective as two-stage laparoscopic Fowler–Stephens’s orchidopexy with preservation of gubernaculum.

Retrospective analysis of laparoscopic and open orchidopexy for non palpable intra-abdominal testes in a tertiary care centre

Purpose: Patients with non-palpable testes has numerous treatment options, the most effective treatment is still controversial. Laparoscopy has nowadays gained the trust as the most reliable modality for the management of impalpable testis. The aim of our study was to retrospectively analyse the laparoscopic and open orchidopexy procedures and report the outcome of our series. Material and methods: 120 patients with 130 non palpable testes with a mean age of patients about 2.7 years who had undergone orchidopexy by open and laparoscopic methods over past 8 years. Results: Mean age of open group was similar to laparoscopic group (2.7 ± 1.7 vs 2.5 ± 1.5 years; p > 0.05). 10 patients (8.33%) presented with bilateral non palpable testes. 10 testes from the open group and 8 from the laparoscopic group were of vanishing variety. Fowler -Stephens staged procedure was done for 4 testes in laparoscopic group. The mean operative time was more in the laparoscopic group than the open (63min vs 47min). Laparoscopic orchidopexy group had generally lesser use of analgesics. The mean hospital stay between the open and laparoscopic groups was 2.1 vs 1.3 days (p <0.05). 12 cases of testicular atrophy were noted, 7 from the open group and 5 from the laparoscopic group. Conclusion: Results of open and laparoscopic orchidopexy procedures were fairly constant. Although, laparoscopy gives significantly less morbidity, is less painful, has lesser hospital stay and is cosmetically better. Keywords: cryptorchidism; laparoscopy; orchidopexy; testis

Laparoscopic orchidopexy for the treatment of cryptorchidism in adults: a description of the technique and outcomes

BackgroundThere are few studies on cryptorchidism in adults, and its treatment is still controversial.MethodsTo summarize the surgical strategy and clinical efficacy of laparoscopic orchidopexy for the treatment of cryptorchidism in adults, 37 adult cryptorchidism patients were retrospectively analyzed between September 2017 and February 2022. All 37 patients underwent laparoscopic orchidopexy, of whom 33 underwent inguinal hernia repair without tension. The intraoperative procedures and surgical techniques were recorded in detail. Preoperative examination and regular postoperative review of color Doppler ultrasound, and reproductive hormone, alpha-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase levels were performed.ResultsAll testes descended successfully into the scrotum, including 25 through the inguinal route and 12 through Hesselbach’s triangle route. No intraoperative or postoperative complications were observed. The follow-up time was 38.6 (± 19.4) months, and no evidence of testicular malignancy was found during the follow-up period. After analyzing the reproductive hormone levels at 1 year postoperatively in 28 patients with more than 1 year of follow-up, it was found that the patients had a significant increase in testosterone levels and a decrease in follicle-stimulating hormone levels after surgery. None of the patients showed any significant improvement in semen quality after surgery.ConclusionOur study suggests that laparoscopic orchidopexy is a safe and feasible surgical procedure for the treatment of cryptorchidism in adults, especially high cryptorchidism, which is difficult to treat. After comprehensive consideration, preserving the testis should be preferred for treating cryptorchidism in adults to maximize the protection of the patient’s reproductive hormone secretion function.

Long-term Outcome of Laparoscopic Surgery for Nonpalpable Undescended Testis.

The aim of this study was to objectively assess the long-term results of laparoscopic orchidopexy in patients who were diagnosed clinically to have nonpalpable undescended testis (UDT). All operated cases of nonpalpable UDT from January, 2000, to January, 2014, were reviewed. After informed consent, all patients were subjected to a color Doppler ultrasound examination to assess the location of the testis, its size, blood supply, and consistency. The size of the testis, operated and nonoperated, was noted down in volume using the formula of 0.71 × length × breath × height. A total of 114 patients could be identified, who had undergone laparoscopy for nonpalpable UDT in the study period. Of these, 44 patients (54 units) underwent a color Doppler study to assess the testes. All the testes were found to lie in the scrotum with preserved blood supply. The volume of the operated unilateral testes (mean = 1.605 cm3) was smaller than the normal nonoperated side (mean = 2.524 cm3). The smaller testicular volume was observed in spite of maintained blood supply to the testes. In cases of bilateral UDT, both the testes were smaller in size (mean = 2.2 cm3), but were comparable to each other. In addition, the ultrasound examination revealed the presence of normal homogenous parenchyma of all the testes similar to the nonoperated side. Laparoscopic orchidopexy is a safe and effective option in the treatment of nonpalpable UDT. On a long-term basis, it is possible to achieve scrotal position along with preserved blood flow following laparoscopic orchidopexy in all patients suffering from nonpalpable UDT.

Laparoscopic Orchidopexy after 4 Weeks of Testicular Traction with Preservation of Blood Supply: A New Concept for the Treatment of Intra-Abdominal Cryptorchidism: Original Article

Laparoscopic Orchidopexy after 4 Weeks of Testicular Traction with Preservation of Blood Supply: A New Concept for the Treatment of Intra-Abdominal Cryptorchidism: Original Article

Techniques of staged laparoscopic orchidopexy for high intra-abdominal testes in children: A systematic review and meta-analysis.

Laparoscopic exploration is currently considered the gold standard for managing nonpalpable intraabdominal testes. The problem of short vascular pedicle is addressed in Fowler-Stephen (FS) technique by the division of testicular vessels and in Shehata technique (ST) by traction on testicular vessels. There is a lack of the consensus among pediatric surgeons on the choice of one technique over other. This analysis compares the reported outcomes of staged laparoscopic orchidopexy by ST with the time tested FS technique in managing high intraabdominal undescended testis. The present systematic review and meta-analysis was conducted as per the preferred reporting items for the systematic review and meta-analyses guidelines. Only randomized controlled trials and comparative studies were included. The primary outcomes compared were the incidence of testicular atrophy, testicular retraction/ascent rate, and operative time of Stage I and Stage II orchidopexy. The present analysis was based on three randomized studies with a total of 119 undescended testes in 117 patients satisfying the inclusion criteria. The operative time was less in Stage I FS technique; however, there was no statistically significant difference in operative time of both procedures during the Stage II laparoscopic orchidopexy. Pooled analysis of postintervention testicular atrophy, testicular retraction rate, and duration of postoperative hospitalization showed no difference between both procedures. Both FS and STs are comparable in terms of postintervention testicular atrophy, testicular retraction/ascent; however, the mean operative time is significantly less with FS technique in Stage I laparoscopic orchidopexy.

Surgical and morphological outcome of one-stage laparoscopic orchidopexy with preservation of gubernaculum and interruption of spermatic vessels in comparison to two-stages fowler–Stephens’s orchidopexy technique with preservation of gubernaculum for impalpable testis

Background For the care of nonpalpable testis, laparoscopy has acquired complete acceptability in both diagnostic and therapeutic settings. Standard laparoscopic for situations where the length of the spermatic arteries can prevent tension-free testicular mobilization in the scrotum, Fowler-Stephens’ (F-S) orchidopexy is a widely used and acknowledged procedure. Maintaining a healthy testis’ vascularity requires gubernaculum sparing with testicular vessel cutting. Our research recommends using the F-S approach with the preservation of the gubernaculum in a single stage rather than two phases for the same outcomes. Setting: the pediatric surgery outpatient clinic at hospitals affiliated with Ain Shams University and the Armed Forces Hospitals. Patients and methods This was a Randomized controlled clinical trial (RCT), conducted on boys with nonpalpable testicles between 1 and 6 years old, in 2 Egyptian pediatric surgery units, between October 2019 and September 2022. The patients who met the inclusion criteria were divided into two groups to compare their outcome (atrophy and success rate): (group A with 25 impalpable testicles was subjected to one-stage laparoscopic assisted orchidopexy with interruption of spermatic vessels and preservation of the gubernaculum, while group B with 25 impalpable testicles was subjected to two-stages laparoscopic assisted orchidopexy with interruption of spermatic vessels and preservation of the gubernaculum). Results The mean age of all patients was (3.9±1.8), 113 nonpalpable testicles were examined during the period of our study, and 50 nonpalpable testicles met our inclusion criteria. They were divided into two groups according to surgical procedure. There were no significant differences between the two groups according to age, and preoperative testicular volume. Postoperative outcome (atrophy and success rate) had no significant differences. Operative time and hospital stay were statistically decreased in the group performed with one stage. Conclusion To conclude, one-stage laparoscopic F-S orchidopexy with preservation of gubernaculum is as effective as two-stage laparoscopic F-S orchidopexy with preservation of gubernaculum.

Successful airway management in a child with Edward's syndrome: A case report

The airway management of syndromic pediatric patients is an ongoing challenge for the anesthesiologist. The craniofacial abnormalities and multiple system anomalies in Edward syndrome children require special consideration during the perioperative period. We hereby report the successful airway management of an 8-year-old male child with Edward’s syndrome posted for laparoscopic orchidopexy.

Outcome of redo orchidopexy after previous laparoscopic orchidopexy

Testicular reascent is a recognised complication of orchidopexy, and redo surgery may be required. In this report, we present our experience of redo orchidopexy after initial laparoscopic surgery. Patients who had undergone redo orchidopexy following an initial vessel-sparing (VS) or non-vessel sparing (NVS) laparoscopic orchidopexy between 2005 and 2019 were identified. Outcome data, including complications and testicular size, were recorded. The series comprised 23 patients (5: initial bilateral surgery with reascent on one side only; 18: unilateral surgery) with a mean age at original surgery of 3.5years (range 8months-6years) and at redo surgery, 4years (range 1.5-7years). VS surgery had been undertaken in 15 and NVS in 8. A tension-free scrotal position was achieved in all cases. There were no complications and no patient required orchidectomy. At a minimum of 6-month follow-up after redo surgery, there were no cases of reascent and there was no change in testicular size/volume (based on clinical examination). Redo orchidopexy is an effective treatment following failed laparoscopic orchidopexy and a scrotal testis can be achieved in all cases. Complete testicular atrophy did not occur, but the risk of partial atrophy could not be accurately quantified.

Cryptorchidism in children: Predictive factors of orchidopexy failure and postoperative testicular atrophy

Outcomes of orchidopexy for undescended testes may be disappointing. The aim of our study was to identify predictive factors of testicular atrophy and orchidopexy failure. It was a prospective monocentric study including all boys operated for undescended testes between January 2009 and December 2014. We have recorded for all boys: age at surgery, testes volume and position, epididymo-testicular fusion and spermatic vessels abnormalities, surgical technique, need for extensive cord dissection and tension-free orchidopexy. We have included 688 boys operated for undescended testes. The whole number of undescended testes was 816. Predictive factors for postoperative testicular atrophy in univariate analysis were: testicular position in deep inguinal orifice, intra-abdominal testes, hypotrophic preoperative testes, epididymo-testicular fusion and spermatic vessels abnormalities, laparoscopic orchidopexy, complete testicular vessels skeletonization and under-tension orchidopexy. In multivariate analysis, peroperative testicular hypotrophy and testicular position in deep inguinal orifice have been identified as independent factors of postoperative atrophy. Predictive factors for testicular reascension in univariate analysis were: intra-abdominal testis position, scrotal orchidopexy and under-tension orchidopexy. In multivariate analysis, no independent factor was identified. Peroperative testicular hypotrophy and testicular position in deep inguinal orifice have been identified as independent factors of postoperative atrophy. There was no independent predictive factor for postoperative testicular reascension. 2.

The role of laparoscopy in non-palpable undescended testicle: Analysis and review of the experience from two cities in Sudan.

Introduction:It is estimated that 1%–2% of male infants have undescended testicles. The reliability of ultrasound (US) to identify the non-palpable undescended testicles (NPUDT) is controversial. Laparoscopy remains the gold standard to diagnose and manage NPUDT.Objective:The objective is to highlight the role of laparoscopy in the management of NPUDT in 2 cities from Sudan over the past decade.Materials and Methods:Patients presented to Gadarif Teaching Hospital and Almak Nimir University Hospital with NPUDT were assessed by clinical examination and US. The testis, when found during laparoscopy, was either brought down to the scrotum in a single or two-stage or removed depending on the findings. Data were collected and analysed.Results:Patients covered the age range between 18 months and 65 years. The average was 12.4. The majority, 94 (67.2%) patients were older than 5 years. The main presenting symptom was either bilateral or unilateral empty scrotum. In 12 (8.4%) patients, the main presenting symptom was primary infertility. US was done in 120 (86.6%) of the patients and failed to see the testis in more than half of them. A single-stage procedure in the form of laparoscopic search assisted with orchidopexy was achieved in 90 (62.9%) patients and orchiectomy in 13 (9.1%) patients, while in 12 (8.4%) patients the testis was not found. Other procedures were applied on the 28 (19.6%) patients who needed staged operation in the form of Fowler Stephen's, in bilateral cases, in 6 (4.2%) patients. Shehata's operation in nine patients (64%) and open orchidopexy for 8 (5.6%) patients. The post-operative complication was encountered in 14 (9.8%) of the patients in this group in the form of bleeding, vassal injury and testicular atrophy.Conclusion:Laparoscopy provides the most accurate interventional option for managing patients with NPUDT. Laparoscopic orchidopexy, whether single stage for low or 2-stages for high intra-abdominal testis, is a proven and effective extension of lap-search with minimal complications.

Early Experience with Laparoscopic Surgery for Undescended Testis at a Tertiary Hospital in Ibadan (2015-2019)

Background: Undescended testis (UDT) is of concern to the patient. If not treated may be complicated by trauma, torsion, male sub-fertility, and testicular cancer. In Nigeria it is commonly treated by open orchidopexy or orchidectomy. We report our experience with the laparoscopic management of undescended testes in the Western part of Nigeria.
 Methodology: The aim of this study was to report our early experience with the laparoscopic treatment of undescended testis in our centre. The study was conducted between January 2015 and December 2019. The data studied were age, unilateral or bilateral UDT, operation performed, pre-and intra-operative findings, operation time, and the outcome. The data were represented in tables and with operative pictures. Ethical clearance was obtained.
 Results: A total 12 patients were treated which consisted of 7 children and 5 adults with a mean age of 11 (6-17) years and 35.2 (29-42) years respectively. Preoperatively, 9 patients had transperitoneal laparoscopic orchidopexy, orchidectomy or varicocelectomy. The laparoscopic findings were peeping testis (5), intraabdominal testis (8), intracanalicular (5), and one absent testis. All the post-orchidopexy testes remained in the scrotum at 18 months of follow up. In the adults, there was improvement in the semen parameters in 2 men while 3 had persistent azoospermia.
 Conclusion: In our setting, laparoscopy for undescended testis is feasible, safe, diagnostic, and therapeutic. In infertile men with undescended testis and unilateral varicocele, laparoscopic varicocelectomy results in improved semen quality.

A comparative study between two techniques of laparoscopic orchiopexy for intra-abdominal testis.

Introduction:Several techniques have been described for laparoscopic orchidopexy in patients with intra-abdominal testes. We aimed to report our experience with the staged laparoscopic traction orchiopexy (Shehata technique) and to compare it to the Fowler-Stephens orchidopexy (FSLO).Methods:We conducted a retrospective cohort study at two pediatric surgery departments from 2017 to 2020. Fifty-six patients underwent laparoscopic exploration and the testis was intra-abdominal in 41 of them. Patients with vanished testis or those who underwent open orchidopexy or vessel-intact laparoscopic orchidopexy were excluded. Those who underwent FSLO (n = 18), or Shehata laparoscopic orchidopexy (n = 11) were compared.Results:Preoperative data were comparable between both the groups. FSLO had a significantly shorter first-stage operative time (34.61 ± 6.43 vs. 58 ± 9.39 min, P < 0.001), with no difference in the second stage. There was no difference in the initial position of the testes between both the techniques. The testis dropped from the fixation position in three patients in the Shehata group (27.27%), and consequently, the cord did not increase in length by the second stage, and these testes barely reached the scrotum. At 12 months’ follow-up, the testes’ size, position, and consistency were comparable between the two groups.Conclusion:Staged laparoscopic traction orchidopexy is feasible for the management of intra-abdominal testes, especially in the low-lying testes.

Effect of dexmedetomidine on hemodynamics and recovery profile in children undergoing laparoscopic Stephen–Fowler's Stage-2 orchidopexy under general anesthesia: A prospective randomized controlled study

Background: Stephen–Fowler's Stage-2 (SF-2) orchidopexy for high intra-abdominal testes poses the challenge of both laparoscopic and open urogenital surgery to the pediatric anesthesiologist. Balanced anesthesia supplemented with regional analgesia remains the standard technique adopted. Studies involving intravenous (IV) dexmedetomidine as an adjuvant anesthetic in children are sparse. Aims and Objectives: The aim and objective was to study the effect of IV dexmedetomidine on intraoperative hemodynamic stability, airway reflexes, and hemodynamic responses to extubation and postoperative analgesia. Materials and Methods: This prospective randomized controlled study was conducted on thirty children undergoing laparoscopic SF-2 repair to receive balanced anesthesia with isoflurane. Group D patients received IV dexmedetomidine 1 μg/kg bolus over 10 min after induction followed by an infusion at 0.5 μg/kg/h and Group C patients received regional analgesia. Hemodynamic parameters, sedation, agitation, pain scores, time to rescue analgesia, and time to discharge were documented. Results: A significant change was discernible in the heart rate and systolic blood pressure with intraoperative hemodynamic stability in Group D patients, which was comparable to baseline values. Smoother extubation with better hemodynamic stability (P Conclusion: IV dexmedetomidine 1 μg/kg bolus followed by an infusion of 0.5 μg/kg/h gives better intraoperative hemodynamic stability with smoother extubation and prolonged postoperative analgesia without undue side effects in children undergoing SF-2 orchidopexy.

Clinical efficacy of two-staged Fowler-Stephens laparoscopic orchidopexy in the treatment of children with high cryptorchidism

Objective: To Evaluate the clinic effect of two-staged laparoscopic Fowler-Stephens orchiopexy in the treatment of high cryptorchidism, and compare it with laparoscopic orchiopexy treatment without disconnecting spermatic vessels. Methods: A retrospective analysis was conducted on 20 cases of children with high cryptorchidism who were treated with two-staged Fowler-Stephens orchiopexy from January 2015 to April 2019 (F-S group). All the children in this group had unilateral cryptorchidism, age 6 to 18 months. The average age was 13.5 months. Seven cases were on the left side, and 13 cases were on the right side. There were 20 control children in the same age group who were treated with testicular fixation without disconnecting spermatic vessels, age 6 to 18 months. The average age was 12.5 months. Six cases were on the left side, and 14 cases were on the right side. Testicular ultrasonography and sex hormone examination were conducted before operation. F-S group met the indications for Fowler-Stephens surgical. In the first stage, the testicular vessels were doubly clipped at a site away from the testis in laparoscopic, and the second stage was scheduled about 6 months after the first stage. The children in the control group were treated with laparoscopic orchiopexy without disconnect spermatic vessels. The two groups were followed up to 6 months after the operation, and the testicular volume and sex hormone indexes of the two groups were measured. The testicular volume and sex hormones before and after the operation of the F-S group and the control group were respectively subjected to a self-control study, and a hormone comparison study was carried out between the two groups of children. Results: Both the F-S group and the control group successfully fixed the testes in the scrotum without tension during the operation. In both groups, 20 cases of testicular positions were reexamined 6 months after the operation without retraction. All the patients had a viable testis in scrotum after operation. Two of F-S group had an atrophic testis in the scrotum, and the others had a good vascularization detected on echo color doppler ultrasound. The average testicular volume of F-S group was (0.34±0.16) ml before operation and the postoperative one was (0.38±0.13) ml, P=0.089, P>0.05. In control group, the preoperative average testicular volume was (0.40±0.14) ml, and postoperative one was (0.40±0.15) ml, P=0.933, P>0.05. The testicular volume of two group had no significant difference. Sex hormone reexamination: Testosterone (T), estradiol (E2) and luteinizing hormone (LH) did not change after operation. Prolactin (PRL) in F-S group was 13.44 μg/L before operation and 12.3 μg/L after operation, PRL in control group was from 15.45 μg/L to 10.34 μg/L, P=0.732, the change of prolactin (PRL) has no significant difference. The median preoperative follicle stimulating hormone (FSH) in the F-S group was 1.18 U/L preoperatively and 1.61 U/L postoperatively; the median FSH of the control group was 1.21 U/L preoperatively and 1.1 U/L postoperatively. Compared between the two groups, the postoperative increase in the FS group was higher than that before the operation, P=0.032, P<0.05, the difference was statistically significant. The median of progesterone (PROG) in the F-S group was 0.25 nmol/L before operation and 0.17 nmol/L after operation; the median PROG of the control group was 0.56 nmol/L before operation and 0.24 nmol/L after operation. It was lower after the operation than before the operation, P=0.034, P<0.05, the difference was statistically significant. Conclusions: (1) Laparoscopic Fowler-stephens staging operation is an effective method for the treatment of patients with high cryptorchidism, and it is worthy of further promotion. (2) Disruption of spermatic cord vessels does have an impact on hormones changes. The choice of this surgical procedure should be carefully and fully evaluated.

Laparoscopic orchidopexy and its outcome in the management of nonpalpable testis

Background: Management of impalpable testis represents a significant diagnostic and operative challenge. The aim of this work was to present the superior value of laparoscopy as a single tool for the diagnosis and treatment of impalpable testis.Methods: 51 patients with 58 nonpalpable were included in our study. Study design was case series. We have conducted this study at Surat Municipal Institute for Medical Education and Research, Surat. For each patient laparoscopy orchidopexy was performed and either testis or blind ending cord structure are searched for. The testis either brought down to the scrotum or removed depending on the condition. The patients were followed up for 12 months.Results: On diagnostic laparoscopy the number of testis found normal 54, followed by 3 hypoplastic and 1 atrophic. There were 8 testis found to be present at high intraabdominal (&gt;2 cm from deep ring), 46 were present at low intra-abdominal (&lt;2 cm from deep ring), intracanalicular 4. Postoperative complication included minor wound infection in one patient, none of them were diagnosed scrotal hematoma, port site hernia, and testicular atrophy.Conclusions: Laparoscopy seems to offer a safe and reliable diagnostic and therapeutic option to patients with nonpalpable testis. Intraabdominal dissection allows more testis to be brought down to scrotum. Laparoscopy clearly demonstrate the anatomy and provide visual information upon which a definitive decision can be made.

Laparoscopic management of non-palpable un-descended testes: our experience

Background: The purpose of the study was to determine the sensitivity and specificity of laparoscopy in localizing non-palpable testes, its therapeutic role, mean operative time, conversion rate, complications and hospital stay.Methods: A total of 52 patients were included in the study and was conducted from June 2012 to June 2017. These boys were examined as outpatients, at the time of admission and after general anesthesia to exclude palpable testes and were subjected to diagnostic and operative laparoscopy.Results: We identified 52 patients with 66 non palpable un-descended testes. The most common age of presentation was 1-4 years. Majority of patients i.e. 27 were on the left side. Ultra-sound identified testis &gt;2 cm from deep inguinal ring in 20, near deep ring &lt;2 cm in 20 and at inguinal canal in 6 patients. In the diagnostic laparoscopy, high intra-abdominal testis found in 34, low intra-abdominal testis in 24, blind ending of vas and vessels in 2 patients. The operative procedures performed are diagnostic laparoscopy, laparoscopic orchidopexy, laparoscopic orchidectomy, conversion to open orchidopexy and open orchidectomy. The mean operative time was 53.67±2.37 for unilateral and 102.76±5.38 for bilateral cases. The postoperative complications include surgical emphysema, wound infection and scrotal haematoma. The mean hospital stay was 14.23±2.37 hours for unilateral and 16.27±5.38 hours for bilateral.Conclusions: Laparoscopic orchidopexy appears to be a feasible, minimally invasive, less postoperative pain and trauma, faster convalesce and return to normal activity and an effective technique for the management of low intra-abdominal testes.

Undescended Testes and Laparoscopy: Experience from the Developing World

Background Cryptorchidism or undescended testes is the most common disorder of the male endocrine glands in children. With the advancements in laparoscopic techniques and instruments, laparoscopic orchidopexy has become the standard procedure in the management of nonpalpable undescended testes. Aim To evaluate and determine the therapeutic role, sensitivity, and specificity of laparoscopy in localizing nonpalpable testes and the mean operative time, the conversion rate (and reasons thereof), postoperative wound infection, postoperative stay, and time taken for return to daily activities following laparoscopic orchidopexy or orchidectomy. Materials and Methods This was a prospective study carried out in the Postgraduate Department of Surgery, Government Medical College, Srinagar, J&K, India, from May 2008 to August 2011. All patients who presented to the outpatient department with complaints of absent testes were examined, and the ones with nonpalpable testes were included in the study. Results The mean operative time for bilateral and unilateral nonpalpable testis was 102.76 and 53.67 minutes, respectively. Minor postoperative wound infections were noted in 4 of our patients. Mean duration of hospital stay was 14.23 hrs for unilateral cases and 16.27 hrs for bilateral cases. Patients who underwent laparoscopic orchidopexy resumed their normal activities within 4 ± 1 days. Conclusion Laparoscopy clearly demonstrates the anatomy and provides visual information upon which a definitive decision can be made for further management of the undescended nonpalpable testis.

Gubernaculum Testis and Cremasteric Vessels Preservation During Laparoscopic Orchidopexy for Intra-Abdominal Testis: Effect on Testicular Atrophy Rates

PurposeGubernaculum-sparing laparoscopic orchidopexy (GSLO) - which involves anatomical delivery of the testis through the internal inguinal ring (IIR) - has been proposed as an alternative to Conventional Laparoscopic Fowler-Stephens Orchidopexy (CLO) maximizing collateral blood supply and potentially reducing atrophy rates. Herein, we test this hypothesis by comparing the 2 techniques. Materials and MethodsThe primary (dependent) outcome of this study was the rate of testicular atrophy, which was defined as palpation of a nubbin or the inability to palpate a testis (complete atrophy) on postoperative physical examination at 3 and 12 months. Doppler ultrasound was obtained routinely to further confirm the diagnosis of testicular atrophy. The following independent variables were captured: age at surgery, type of procedure (CLO vs. GSLO), surgical approach (single vs. 2-stage), location of IAT (high vs. low), and patency of the IIR ResultsMean and median age at surgery were 25.7±13.3 and 22 months respectively. Laparoscopy was carried-out for NPT, showing: vanishing IAT in 120 (29%), peeping testes in 80 (19%) and IAT in 212 (51%; 104-low and 108-high). A 1-stage procedure was performed in 44(21%) cases and 2-stage in 168 (79%). CLO was undertaken in pts 46 (22%) and GSLO in 166(78%), based on surgeon preference. The overall atrophy rate was 6.6% (14/212). 13 of 46 testes atrophied after CLO vs 1 of 166 following GSLO (28.3% vs 0.6%, p=<0.01). ConclusionsGSLO is a feasible alternative to CLO. Our findings suggest that preservation of additional vascular supply to the testis (cremasteric vessels and deferential artery as opposed.

Evaluation of two-staged Fowler–Stephens laparoscopic orchidopexy (FSLO) for intra-abdominal testes (IAT)

The best operative intervention for intrabdominal testis (IAT) has not been standardized as yet. The question of whether to bring down an IAT with a single-staged vessel-intact laparoscopic orchidopexy (VILO) or a two-staged laparoscopic Fowler-Stephens orchidopexy (FSLO) is still undergoing debate, with both the procedures being popular. The present study has been designed to evaluate the factors predicting the success or failure of two-staged FSLO for (IAT). 43 boys with 49 non-palpable testes underwent diagnostic laparoscopy out of which 35 underwent two-staged FSLO. Size of the testis was measured with a graduated probe in both stages. Independent variables such as age, height, testis-to-internal ring distance (T-IR), neo internal ring-to-midscrotal distance (NIR-MS), and mobility-to-contralateral ring (MCIR) were analysed. Postoperatively 34 IATs were followed up clinically as well as ultrasonologically after 6 months, to see for the size, position, and vascularity. Based on this, the patients were divided into two groups, Group A (successful) and Group B (Failed). 24 IATs had a successful outcome (Group A) and 11 were failure (Group B). The overall success rate of the study was 68.6%. The difference in mean age of patients in both groups was insignificant (p = 0.89) (Fig. 1), and similarly, the difference in mean height was insignificant (p = 0.61). The difference in mean T-IR in both the groups was insignificant (1.85 versus 2.77cm; p = 0.09) and mean NIR-MS was 5.41cm in Group A and 5.10cm in Group B, and the difference again was insignificant (p = 0.23). The success rate of FSLO was 68.6%. None of the above-described independent variables have any effect on the outcome of two-staged FSLO. While VILO remains the treatment of choice for IAT located at or near the ring, but IAT higher than this, two-staged FSLO gives a better chance for achieving intra-scrotal orchidopexy.