Laparoscopy in the management of the impalpable undescended testis

St James's University Hospital and the General Infirmary Leeds, UK.
British Journal of Surgery (Impact Factor: 5.21). 08/1998; 85(7):983-5. DOI: 10.1046/j.1365-2168.1998.00748.x
Source: PubMed

ABSTRACT This study evaluates the role of laparoscopy for managing the intra-abdominal testis.
Over 30 months, 48 children (six with previous groin explorations) underwent laparoscopy for a unilateral impalpable undescended testis. The patients' age ranged from 1 to 9 years.
Eleven children required insertion of 'working ports' for mobilization of obscuring colon before the diagnosis could be established. Twenty-eight children had an absent testis. In nine, vas and vessels entered the internal ring. In 19, vas and vessels ended blindly above the internal ring. Twenty children had an intra-abdominal testis. Ten underwent a laparoscopic single-stage orchidopexy (eight without and two with ligation of vessels); at a minimum follow-up of 2 years, one testis in this group had atrophied, three were located in the lower half of the scrotum and six in the upper half. The remaining ten children underwent a laparoscopic two-stage Fowler-Stephens operation. At a minimum follow-up of 6 months, eight of these testes were palpable in the lower half and two in the upper half of the scrotum. CONCLUSION In the majority of cases, laparoscopy obviates the need for groin exploration. Technically a first-stage Fowler-Stephens procedure can be performed easily and effectively via the laparoscope. However, the second-stage Fowler-Stephens procedure or single-stage orchidopexy requires laparoscopic skills and may not necessarily provide sufficient length to the testicular attachment.

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    • "All of these anatomical landmarks individually or collectively have bearing on the operative management of the Impalpable testes. (Atlas & Stone 1992; Bianchi, 1995; Bogaert et al. 1993;Elder, 1993; EI Gohary, 2006; Froeling et al.1994;Humphrey et al. 1998; Poenaru et al.1994; Perovic& Janic 1994) "
    Advanced Laparoscopy, 09/2011; , ISBN: 978-953-307-674-4
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    ABSTRACT: Laparoscopy and magnetic resonance imaging (MRI) are competitive tools in the diagnosis of non-palpable testis. A prospective evaluation to determine the accuracy of MRI vs laparoscopy in the detection of undescended non-palpable testis was performed in 13 boys with 15 non-palpable testes. The results were compared between MRI, laparoscopy and definitive surgical diagnosis in all patients. MRI have reached a correct diagnosis in 13 out 15 non-palpable testes (86.6%). Three testes were located intra-canalicular, 5 were located just-canalicular, 3 were located intra-abdominal on the sides of urinary bladder. In the other 2/13 cases MRI showed small poorly defined testes with low signal intensity on both T1 and T2-weighted images indicative of fibrotic changes. These 2 testes proved to be atrophic after surgical exploration. MRI failed to detect or localize undescended non-palpable testis in 2 cases. On the other hand, initial laparoscopy revealed 5 testes to be intra-abdominal, and another 5 testes to be just-canalicular. Laparoscopy diagnosed inguinal testis in 3 instances, in which the vas and vessels were seen entering an open internal ring. In another 2 cases, the vas and vessels have entered a closed internal ring, they were diagnosed as vanished or atrophic testes in the inguinal canal. We recommended the use of non-invasive, non-ionizing MRI initially for all children with non-palpable testes to locate normal or atrophic testis, as a positive MRI finding locates the testis reliably, and limit minimally invasive diagnostic laparoscopy to patients with negative MRI findings.
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    ABSTRACT: In the past 20 months we have performed laparoscopy on 14 boys with 18 impalpable testes. Their age ranged between 1 year 3 months and 7 years. Seven boys had left empty scrotum, 3 had right empty scrotum while the other 4 had bilateral disease. At laparoscopy on 6 occasions the vasdeferens was found to enter the internal ring. Four of these 6 patients had closed internal ring and groin exploration was done in them to excise atrophied testis. On 2 occasions the vas was entering an open internal ring. One of these patients had an inguinal testis which was pexed through the groin route while the other had an atrophied small testis which was excised laparoscopically. Of the 12 testes located in the abdomen one was atrophic and at the internal ring. This was removed laparoscopically. The other 11 were either at the internal ring or at a higher level. All these 11 testes were brought down in to the scrotum by mobilization of the testicular vessels and the vaszdeferens. Two testes in the same patient were brought down through the inguinal canal while the other 9 were brought down through the anterior rectus sheath making a new opening. On 5 occasions the mobilization was difficult. All the testes were placed in the subdartos pouch. Operating time varied between l / 2 hour (diagnostic) and 2 hours. The average postoperative stay was 2 days. One child had urine leak from an injury to the urinary bladder. At follow up 3 testes were at high scrotal position while one was near the pubic crest. There was no testicular atrophy. available are extended groin approach, 1 preperitoneal exploration, 2 two stage or one stage Fowler Stephen method 3,4, Microvas-cular transplantation 5 and laparoscopic orchiopexy. 6 Laparoscopy is perhaps the best method for localization of non-palpable testis. 7,8,9 With the refinement of laparoscopic skills it is natural that more and more surgeons perform one stage orchiopexy without division of spermatic vessels.
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