Laparoscopic inguinal exploration for impalpable undescended testis: can we avoid the open inguinal exploration altogether?

Abstract

Introduction Diagnostic laparoscopy is the gold standard for evaluating a child with impalpable undescended testis (UDT). During the diagnostic laparoscopy, if the vas and vessels are seen coursing through the inguinal canal, the standard norm is to explore the inguinal canal via an inguinal crease incision. In this study, however, we explored the feasibility of laparoscopic inguinal exploration without any additional inguinal crease incision. Materials and methods The prospective study was done from 1.1.2019 to 30.6. 2019 to assess the feasibility of the laparoscopic inguinal exploration in cases of impalpable undescended testis, where testicular vessels are found to course into the inguinal canal during a diagnostic laparoscopy. The data including the descriptive characteristics, intraoperative findings, and surgical technique were collected and analysed. Results There were 17 cases of impalpable UDT operated in the Department of Pediatric Surgery from January 2019 to June 2019. Mean age of the patients was 8.5 years (1-16 years). Two patients had testicular vas and vessels coursing through the inguinal canal, both of which underwent laparoscopic inguinal exploration. In both of these cases, vas and vessels were found to end in testicular nubbin, at the level of the neck of the scrotum, which were excised laparoscopically, thus avoiding the open inguinal incision. Conclusion Laparoscopic inguinal exploration is a feasible and attractive alternative in cases of impalpable UDT where testicular vas and vessels are found to course through the inguinal ring.

The Management of Intraabdominal Testis: A Survey of the World Federation of Associations of Pediatric Surgeons (WOFAPS) Practices

“…Esposito et al ( 36 ) prefer laparoscopic inguinal exploration if the DIR is open, as the intraabdominal testis might have been migrated into the inguinal canal by the effect of abdominal insufflation, leaving exploration via the open surgery to patients with a closed DIR. In a more recent study, laparoscopic inguinal exploration was feasible in cases of impalpable UDTs, irrespective of the status of the DIR or the appearance of the testicular vessels; however, this study was limited by the small number of included cases ( 37 ).…”

Does the presence of blind-ended vas deferens and spermatic vessels in laparoscopic exploration of non-palpable testes conclusively indicate testicular absence?

“…The primary objective of surgery for NPT exploration is to determine the presence of viable testes, which can only be achieved by exposing the terminal end of the VDSV, with excision not adding significantly to the surgical time in such cases ( 31 ). On the other hand, considering the potential malignant precursor in atrophic nodules, most surgeons prefer excising the nodules during exploration, with laparoscopic inguinal exploration serving as a good alternative to open inguinal exploration ( 32 ). In line with our study, where laparoscopic exploration revealed blind-ended VDSV, we proceeded with inguinal exploration and excision of atrophic testicular nodules, whereas previous extensive research ( 1 , 5 , 6 , 15 ) classified this condition as testicular absence, thereby not exploring further.…”