Single-Port Laparoscopic Assisted Transcrotal Orchidopexy for Palpable Inguinal Canalicular Cryptorchidism Accompany With Indirect Inguinal Hernia

Abstract

Purpose: To assess the outcomes of a novel laparoscopic assisted transcrotal orchidopexy (LATO) combined with percutaneous extraperitoneal closure (PEC) for palpable inguinal canalicular cryptorchidism accompany with indirect inguinal hernia, and evaluate its safety and efficiency.Materials and Methods: A retrospective cohort study for single-port LATO-PEC and traditional inguinal orchidopexy (TIO) was performed between 2011 and 2014. Totally 53 children with both palpable inguinal canalicular testes and indirect inguinal hernia were included. Median patient age was 15month (range, 6 months to 4 years). Of them, 35 patients underwent LATO-PEC procedure, utilizing an umbilical trocar for laparoscope, transcrotal dissection for orchidopexy, and an inner two-hooked cannula for ligation of the patent processus at the level of the internal ring. Three of them were bilateral, 12 on the left side and 20 on the right. Eighteen patients received TIO, seven of them on the left side and 11 on the right. Patient demographics, surgical technique, complications, and clinical outcomes were reviewed. Follow-up visits were performed to reassess position and size of the testes.Results: All 56 undescended testes were delivered into the scrotum successfully. In the LATO-PEC group, nine contralateral herniorrhaphy were accomplished simultaneously. Fifteen contralateral patent processus vaginalis (PPVs) in 32 unilateral undescended testis (UDT) were newly confirmed during the laparoscopy, while 6 of them received percutaneous extra-peritoneal herniorrhaphy for visible inguinal bubble in pneumoperitoneum condition. No additional port placement or conversion to open procedure was needed. Mean operative time for unilateral and bilateral LATO-PEC in this study was (37.81 ± 5.23) min and (53.33 ± 2.98) min, respectively. In TIO group, mean operative time was (41.11 ± 8.67) min. There was no statistical difference in operative time between the two approaches for unilateral UDTs (p = 0.098). Median follow-up interval was 24 months (range, 12–84 months). No operative complications were found in either group to date.Conclusions: Singe-port LATO-PEC is a safe, effective, and cosmetic choice for inguinal canalicular cryptorchidism accompany with indirect inguinal hernia, minimizing injuries to the vas deferens and testicular vessels. Laparoscopy can provide a diagnostic and therapeutic solution of contralateral PPV.

Comparison of the Detection and Ligation of Patent Processus Vaginalis Between Laparoscopy-Assisted Transscrotal Orchiopexy and Single Scrotal Incision Orchiopexy

“…If cPPV exists, ligation can be performed to close it and avoid a second surgery. The prevalence of cPPV was 45% (9/20 testes) in our LATO group, which is comparable to that reported by Ma (46.8%, 15/32 low palpable UDT) (13) and You (46.8%, 223/677 inguinal palpable UDT) (20).…”

“…A potential bias of our study is reflected in the significantly lower PPV rate (58.1%) of our LATO approach group compared with that (100%) of the published LATO approach groups (13,14). The patency rates of PV differ according to testicular location in cryptorchidism; in particular, a distal testicular location is associated with a low patency PV rate (30).…”

“…However, these determination methods are difficult in some circumstances, especially when the PV opens in the inner ring but wholly or partially obliterates along the cord (15). According to previous studies, the detection rates of PPV mostly range from 20 to 59% in transscrotal orchiopexy cases (16)(17)(18)(19), which are lower than the rate of PPV (90%) in laparoscopic orchiopexy for palpable inguinal UDT (20,21) and that of PPV (100%) in LATO for low palpable UDT (13,14). In fact, the transscrotal approach has also been used in hydrocele repair in pediatric patients, with a patency rate of 66% (20/30 cases) in the 0-to 5-year age group (22).…”

“…Compared with traditional inguinal repair, the processus, if patent, is dilated via pneumoperitoneum, and magnifying the area using laparoscopy makes it easier to distinguish the orientation of the processus (10). In 2018, Ma et al (13) first introduced laparoscopy-assisted transscrotal orchidopexy (LATO), which was laparoscopic percutaneous extraperitoneal closure combined with transscrotal orchidopexy, to manage palpable inguinal UDT. Similarly, in 2020, Saka et al ( 14) reported a similar technique for treating intracanalicular and extracanalicular UDT with promising results.…”

Comparison of Single-Incision Scrotal Orchiopexy and Traditional Two-Incision Inguinal Orchiopexy for Primary Palpable Undescended Testis in Children: A Systematic Review and Meta-Analysis

“…Cuda et al reported their clinical experience that the rate of laparoscopic and scrotal orchiopexy increased, whereas the inguinal orchiopexy decreased ( 25 ). The laparoscopic technique gradually tends to have fewer incisions and even a single port, and the single practice trend is becoming more and more warrant in minimal invasive surgery ( 33 ). SISO meets the concept of being minimally invasive and the demands of patients; it is a safe, effective, promising, and potential surgical approach alternative to TTIO.…”