Is laparoscospic orchidectomy the treatment of choice in adults with impalpable testis in rural hospitals in the developing world?

Abstract

This study was undertaken in order to evaluate the feasibility and safety of performing laparoscopic orchidectomy (LO) in men for unilateral impalpable testis in non-teaching rural hospitals in a developing country. We also investigated the possibility of reducing the cost and length of stay in hospital for patients undergoing LO. This is a prospective analysis of patients with impalpable testis undergoing LO in three non-teaching rural hospitals in the Kashmir Valley from January 2001 to March 2007. The cohort represented men requiring LO aged 15 to 62 (mean 36.2) years. The main outcome parameters assessed included mortality, conversion to an open procedure, complications, reduction in the costs and the length of the hospital stay. Forty-eight men with unilateral undescended testis on physical examination were studied. During laparoscopy the testis was identified near the deep ring in 30 patients, intra-abdominally in 16, and two had blind-ending vas and spermatic vessels near the deep ring. In 46 patients orchidectomy was performed. There were no deaths and none of the patients required conversion to an open procedure. Using reusable instruments, 00 degrees polyglactin sutures and self-made extraction bags, about US$ 300/patient was saved. There was no case of malignancy of the testis on histopathology examination. LO is one of the most satisfactory methods for the management of men with impalpable testis, having both a diagnostic and a therapeutic role especially for patients in the underdeveloped countries. These simple methods can reduce the cost and the length of the hospital stay.

Recent advances in benign gynecological laparoscopic surgery

“…Even though laparoscopy has thrived in high-income countries, it is still inaccessible for the majority of people around the world, who live in low- and middle-income countries (LMICs). Laparoscopy has the potential to have a greater benefit in terms of mortality and morbidity in areas such as LMICs, where there may not be access to clean water, sanitation, blood banks, advanced diagnostic imaging, or interventional radiological procedural services 125 , 126 .…”

Improving Access to Laparoscopy in Low-Resource Settings

“…Global health investors have historically prioritized infectious disease and maternal-child health over surgical care, despite the fact that nearly one third of the global burden of disease arises from surgical conditions [141516]. The mortality and morbidity benefits of laparoscopy are potentially greater in locations such as LMICs that may lack clean water, sanitation, blood banks, advanced diagnostic imaging, or interventional radiological procedural services [1591718192021]. In LMICs, laparoscopy has been associated with a greater than 50% reduction in post-operative wound infection rate, hospital stay may be several days shorter, and convalescence can be several weeks faster compared to open surgery [17212223].…”

“…Laparoscopists in LMICs have described numerous device workarounds, implying a market for private industry to engineer devices for reusability, durability, cost, simplified maintenance, and avoidance of consumables [15671934]. These device shortcomings prove that opportunities exist for improvement to be made which consider local contexts and capacity.…”

“…For these companies vested in local population health, developing markets and maintaining healthy workforces is crucial [39]. As laparoscopy is frequently performed on working-aged individuals and results in quicker return to work, foundation investments in laparoscopy would be philanthropic and self-interested [119]. Often, multinational organizations can use their expertise to begin programs which later transition to another funding source.…”