Staged laparoscopic traction-orchiopexy for intraabdominal testis (Shehata technique)

Shehata, Sameh; Shalaby, Rafik; Ismail, M.A.; Abouheba, Mohamed; Elrouby, Ahmed

doi:10.1016/j.jpedsurg.2015.10.063

Cited by 54 publications

(49 citation statements)

References 13 publications

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“…This study presents the first results of SLTO performed in the UK to date, and confirms similar outcomes to the available international literature [22][23][24]. The study was limited, however, by a small sample size and short follow-up.…”

Section: Discussionsupporting

confidence: 84%

“…4 At the second stage of SLTO for a right intra-abdominal testis (T), the gonadal vascular pedicle (V) has elongated and is no longer under tension when an instrument is placed under the pedicle testicular traction feasible. Shehata et al published a series of 140 cases of SLTO for IAT, and described a traction suture slippage rate of 11% and overall success rate of 84% [22]. More recently, the same authors replicated their technique on 34 IAT with similar slippage rates and 100% of fixed testes were seen to be well vascularized on Doppler ultrasound at follow-up [23].…”

Section: Discussionmentioning

confidence: 98%

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Staged laparoscopic traction orchidopexy for impalpable testes: a preliminary study

2019

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Purpose Laparoscopy is the gold standard to assess for presence of an intra-abdominal testis. However, techniques for the subsequent orchidopexy vary, and include the recently described staged laparoscopic traction orchidopexy (SLTO) (Shehata in Pediatr Surg 51(2):211-215, 2016). SLTO enables elongation of the testicular vessels without division, with initial success rates reportedly superior to Fowler-Stephens. We present the first UK data following a preliminary study using SLTO. Methods 19 boys prospectively presenting with 22 intra-abdominal testes (IAT) underwent STLO in a single centre, with a median age of 2.5 years (IQR 1.4-5.2) at first stage. 3/19 (16%) boys had bilateral IAT and nine (41%) were left-sided. Pneumoperitoneum was established using 5 mm umbilical and 3 mm accessory ports in bilateral iliac fossae. The gubernaculum and lateral peritoneal attachments were divided prior to securing the intra-abdominal testis to the contralateral anterior abdominal wall with 2/0 Ti-cron™. Second-stage procedures were planned for 3-6 months later. The securing stitch was cut; an 11 mm STEP port was placed trans-scrotally to retrieve the testis and secured in a sub-dartos pouch. Outcome measures included palpable testes in the scrotum and surgical complications. Results 13/22 IAT have undergone follow-up. Twelve (92%) IAT were palpable in the scrotum following SLTO. There was one diathermy-related bladder injury necessitating laparoscopic repair, and 3/22 (13.6%) slipped sutures, requiring repeat first-stage procedures. Conclusions Staged laparoscopic traction orchidopexy is a feasible technique, which can be performed as an alternative to Fowler-Stephens procedure, with potentially better outcomes for the testis. The complications described should be preventable as the technique evolves.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 98%

Staged laparoscopic traction orchidopexy for impalpable testes: a preliminary study

2019

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“…In the 1st-stage, the testis is fixed in the correct position, and the intestine pushes the spermatic cord backward and downward. With the help of chronic compression of the intestine or continuous traction of respiratory movement, spermatic cord blood vessels can be gradually extended, and testicular ischemia caused by forced pulling is avoided, which is also the greatest advantage of this technology (24). In this study, it was observed during the 2ndstage of surgery that the spermatic cord blood vessels adhered to the bladder in one case.…”

Section: Discussionmentioning

confidence: 74%

Comparison of Two Types of Staged Laparoscopic Orchiopexy for High Intra-Abdominal Testes in Children: A Retrospective Study From a Single Center

et al. 2021

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Background: To evaluate the efficacy and safety of 2nd-stage laparoscopic traction orchiopexy (Shehata technique) compared to Fowler-Stephens (F-S technique) for high intra-abdominal testes (IATs) in children.Patients and Methods: We performed a retrospective review of all children (<14 years old) who underwent laparoscopic treatment of high IAT in the pediatric surgery center of Yijishan Hospital of Wannan Medical College from April 2016 to April 2020. Participants were divided into the Fowler-Stephens (F-S) group and Shehata group according to the surgical method. We collected the medical records of all children and analyzed them statistically.Results: In this study, 43 patients in our center received 2nd-stage laparoscopic surgical treatment. The results showed that there were 23 high IATs in 22 patients in the F-S group and 22 IATs in 21 patients in the Shehata group. All patients completed the operation successfully. No significant difference in operation time was noted between the two groups. There was no significant difference in the testicular atrophy rate between the two groups (P = 0.323). The testicular retraction rate of the F-S group was greater than that of the Shehata group (P = 0.04).Conclusion:The results of this study indicate that the application of assisted laparoscopic testicular traction technology can effectively retain the main blood supply of the testis and vas deferens with a high survival rate and clear advantages. The preliminary results show that the Shehata technique is safe, reliable and effective in the treatment of high IAT in children.

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“…The authors reported an overall success rate was 84% in 140 testes, with higher success in younger patients. 37 …”

Section: Novel Modifications and Proceduresmentioning

confidence: 99%

The Nonpalpable Testis: A Narrative Review

Shepard

Kraft

2017

Journal of Urology

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Purpose While the nonpalpable testis represents only a small portion of all cryptorchid testes, it remains a clinical challenge for pediatric urologists. Many controversies about the best evaluation and management exist. This narrative review serves as an update on what is known about the nonpalpable testis: etiology, pre-operative evaluation, the best surgical management, novel techniques, and ongoing controversies. Materials and Methods A Pubmed® and MEDLINE® search limited to January 2000 to January 2017 was performed using relevant key terms. Of 367 articles, a total of 115 manuscripts were considered for inclusion based on an a priori design. Utilizing a narrative review format, an update on the evaluation and management of the nonpalpable testis including novel concepts and techniques was synthesized. Results The nonpalpable testis should be evaluated by physical exam only. Imaging is not indicated for the routine case. The optimal surgical approach and technique remains debated, but several novel techniques have been described. Due to the rarity of the nonpalpable testis, randomized controlled trial and other quality comparisons are difficult. Therefore, several controversies in management remain. Conclusions The evaluation and management of the nonpalpable testis remains difficult and some aspects remain debated. Future research should focus on multi-institutional collaborative trials to determine the optimal operative management.

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Staged laparoscopic traction-orchiopexy for intraabdominal testis (Shehata technique)

Cited by 54 publications

References 13 publications

Staged laparoscopic traction orchidopexy for impalpable testes: a preliminary study

Staged laparoscopic traction orchidopexy for impalpable testes: a preliminary study

Comparison of Two Types of Staged Laparoscopic Orchiopexy for High Intra-Abdominal Testes in Children: A Retrospective Study From a Single Center

The Nonpalpable Testis: A Narrative Review

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