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.
"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) "
"There are three main locations of impalpable testes: 40% of all impalpable, undescended testes are located intraperitoneally; 15% are vanished testes; and 45% have cord structures entering the internal inguinal ring [5,6]. For the assessment and diagnosis of impalpable, undescended testes, several diagnostic imaging tools, such as computed tomography or magnetic resonance imaging, cannot give us 100% reliable information about testes [12,15,16]. "
[Show abstract][Hide abstract] ABSTRACT: Controversy exists regarding the best approach to impalpable testes. We determined the usefulness of diagnostic laparoscopy for the management of impalpable testes.
Between 2000 and 2008, 86 patients with a mean age of 34 months underwent diagnostic laparoscopy. An inguinal canal exploration was performed in all cases, except in patients in whom the internal spermatic vessels terminated intraperitoneally with a blind end.
The undescended testis was right-sided in 24 patients (27.9%), left-sided in 47 patients (54.7%), and bilateral in 15 patients (17.4%). Three patients (3.5%) had bilateral impalpable testes. The vas and vessels traversed the internal ring in 51 of 89 impalpable testes (57.3%); 20 (22.5%) were localized intraperitoneally, and 18 (20.2%) were diagnosed as vanishing testes. Open orchiopexies were performed on 24 testes (27.0%) and orchiectomies were performed on 43 nubbin testes (48.3%). After a mean follow-up period of 30 months, 12 of the 14 testes (85.7%) were viable following open conventional orchiopexy, compared with 6 of the 10 testes (60%) following a 1-stage Fowler-Stephens orchiopexy.
Diagnostic laparoscopy is a very helpful and minimally invasive technique in the diagnosis of impalpable testes, especially when preoperative ultrasonography is not sufficiently informative.
Korean journal of urology 05/2011; 52(5):355-8. DOI:10.4111/kju.2011.52.5.355
[Show abstract][Hide abstract] ABSTRACT: Laparoscopic a Background. The education in pediatric surgery is knowing a very fast evolution which is tied with the increasing formative demands from the students and the technological, computer science evolution and robo- tics, that it has been involved our clinical specialty that expresses new aspects for quality of pathology and therapeutic approach. The educational aspects must necessarily include fundamental sta- ges of apprenticeship like the cultural increase that concurs with the fu- ture surgeon to formulate the diagnosis; the possibility to formulate one therapeutic strategy; to choose correct surgical technicque on the diffe- rent base options; finally the development of the manual ability for the corrected execution of the chosen operating techniques.Currently these stages come true trough a process of "progressive imbibition" that is in- volved the "old tutor" who guides the students in the course of the clini- cal activities and particularly to the operating table. More recently, the new computer science technologies and the surgical technical new deve- lopment, particularly those minimally invasive ones, have modified the learning process in deep way because their application preview training different from that traditional one. Methods. In 2005 it has been lead a surveying from part of the Federspe- cializzandi, appeared on "il Sole 24 Ore" that it has found like the greater amount of training doctors interviewed is unsatisfied of the educational porcess. On the basis of this surveying, we have deepened, in our disci- pline, some aspects that express regard the education by means of a que- stionnaire to all the Directors of the Italian Schools of Pediatric Surgery. Result. The answers, coming from 12 centers, have indicated the ne- cessity that the theoretical formation comes integrated from monothe- matic ourse, from interactive Didactics eventually supported from com- puterized aid, from images and video above all with the purpose to rea- lize of the plans formed to you it articulates to you that they prescind and they extend the belongings center. Conclusion. Virtual Truth (V.T.) it is an emergent technology that is acquiring a relief and a spread in always greater surgical field. This technique of programming previews the atmosphere simulation and si- tuations created from the computer where is possible to interact by means of a dedicated software. In perspective, the formation of the pe- diatric surgeon in the III millenium strongly will be conditioned from a role of the computer science that will have widely to integrate the tradi- tional didactic methods us, without to replace them, in the within of new pedagogical dynamics. With these presupposed, he will be easier, for the training schools to guarantee instructive plans suitable, aiming the putting to point of a clinical methodology which respects the four fundamental stages of the apprenticeship.
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