Laparoscopy-Assisted Orchidopexy: An Ideal Treatment for Children with Intra-Abdominal Testes

Abstract

Laparoscopic orchidopexy is the logical extension of diagnostic laparoscopy for the evaluation of NPT. Concerning the technique, we believe that LAO with intact spermatic vessels could be considered the treatment of choice in the patient with IAT, as it does not affect normal testicular vascularization. Alternatively, in the case of very high IAT (more than 3 cm from IIR), an FS procedure may be considered.

Current indications for laparoscopy and retroperitoneoscopy in pediatric urology

“…The diagnostic laparoscopy is undoubtedly more suitable for identifying the different anatomic conditions: blind ending cord structures (20%), cord elements entering the internal inguinal ring (45%), testis agenesis (2%), or an intraabdominal testis (33%) [7,12]. With respect to the most suitable operative technique for intraabdominal testis, most authors prefer the Fowle-Stephens procedure.…”

“…During the first step, the inner spermatic vessels are clipped 4-cm away from the testis. After an interval of 3 to 6 months, which are necessary for the development of collateral vascularization deriving from the deferential vessels, the second step is performed by sectioning the inner spermatic vessels and performing the orchidopexy via the internal inguinal ring or a neoring created medially to the epigastric vessels [12].…”

“…With this technique, the inner spermatic vessels are first dissected from the posterior peritoneum. Then an orchidopexy is performed us the same procedure described earlier [12]. In cases of atrophic intraabdominal testis, the orchiectomy can easily be performed laparoscopically [21,24].…”

“…Currently, about 75% of all urinary pathologies in adults involving the intraluminal surface of the urinary tract are treated endoscopically [4,15]. In the field of pediatric urology, the most important developments in laparoscopy have occurred only in past 5 to 8 years [10,12].…”

Laparoscopy for the Undescended Testes

“…On removing the ports , hemostasis should also be assessed at the port sites, as well as being sure that the umbilical closure does not include bowel or omentum . Esposito et al 36 reported their experience with diagnostic laparoscopic in 85 children with nonpalpable testes, of whom 25 children had intra-abdominal testes. In 24 children laparoscopic orchidopexy was successful.…”