Page 13 - Laparoscopic Surgery Online Journal

WJOLS
10.5005/jp-journals-10033-1196
Laparoscopic Orchidopexy without Division of Spermatic Vessels using a Neoinguinal Canal Approach
ORIGINAL ARTICLE
Laparoscopic Orchidopexy without Division of Spermatic
Vessels using a Neoinguinal Canal Approach: A Single

Center Experience

Ved Bhaskar, Manash Ranjan Sahoo

ABSTRACT INTRODUCTION
Introduction: About 1 to 2% of boys at age of 1 year have an Cryptorchidism is a common urological problem with
undescended testis (UDT); almost 20% of UDT are nonpalpable.
1 to 2% of boys at age of 1 year having an undescended
Several surgical procedures have been described but there
are no formal guidelines for the management of boys with testis (UDT); this disorder is unilateral in about 90% of
nonpalpable testis. We report our experience with laparoscopic individuals and bilateral in about 10%. Almost 20% of
orchiopexy performed without dividing the spermatic vessels undescended testes are nonpalpable. 1 Important potential
in this case series over a period of 4 years stating that the
Fowler-Stephens technique is no longer indicated for the long standing effect of cryptorchidism include infertility and
treatment of the intra-abdominal testis. testicular cancer.
The importance of a descended testis has been known
Materials and methods: Over a period of 7 years from 2005
to 2012, we carried out diagnostic laparoscopy on 50 since ancient times, but the mechanism of descent remained
nonpalpable intra-abdominal testis in 45 boys followed by obscure until 1786 when Hunter dissected the human fetus
laparoscopic orchiopexy without sectioning the spermatic and found the intra-abdominal testis connected to the
vessels even in cases where testis was higher up (30 cases).
The technique consisted in sectioning the gubernaculum, inguinal-abdominal wall by a ligament called gubernaculum
opening the peritoneum laterally to the spermatic vessels, and testis because it appeared to guide the testis to the scrotum. 2
mobilizing the testicular vessels and the vas deferens in a Numerous factors interact to effect normal testicular
retroperitoneal position for 8 to 10 cm. The testis was then
development and descent including endocrine, paracrine,
brought down into the scrotum through a neo-inguinal ring
created just lateral to medial umbilical ligament. growth and mechanical factors. Any abnormality in this
process can result in an undescended testis, which carries
Results: Out of 45 cases with 50 undescended testis, 30 testes
were abdominal, away from the internal ring out of which we fertility and malignancy implications. Infact recent studies
were able to bring 28 testis in the scrotum without dividing the even show a relation of genitofemoral nerve to descent of
spermatic vessels, using a neo-inguinal ring. The other two testis in mice models. 3
patients had to undergo orchidectomy because of atretic testis.
In the remaining 20 cases, the testis was at the inguinal ring or UDT is defined as a testis that cannot be manipulated to
close to it and mobilized easily through the neo-inguinal ring to the bottom of the scrotum without undue tension on the
scrotum. The mean follow-up period has been 14 months spermatic cord. There is variability in nomenclature relating
(6 months to 2 years) and all the testes were found to be in to UDT but the clearest classification is palpable and
scrotum with no atrophy. 4
nonpalpable testis.
Conclusion: On the basis of our experience, we believe that
UDT are usually evaluated and managed by imaging
laparoscopic orchiopexy without division of the spermatic 1
methods and surgery, respectively. Management of the
vessels should be the treatment of choice in the management
of nonpalpable testes because it does not compromise the nonpalpable testis is a diagnostic and therapeutic challenge.
normal testicular vascularization. Creation of neo-inguinal The diagnostic difficulty involves determining if such a testis
canal lateral to the medial umbilical ligament has the
is present and, if so, its location and further management.
advantage of gaining more length on the vessels and vas to 5
bring the testis to scrotum and hence Fowler-Stephens Laparoscopy was first used in 1976 to locate UDT.
procedure is no longer routinely indicated in management of Treatment of the patient with abdominal testis is
high abdominal testis. controversial. Difficulty in mobilization, as well as

Keywords: Neo-inguinal ring, Laparoscopic orchidopexy, significant complications including atrophy, have led to a
6
Undescended testis, Subdartos pouch. multitude of approaches to this dilemma. This scenario is
How to cite this article: Bhaskar V, Sahoo MR. Laparoscopic not new, and all pediatric surgeons are familiar with the
Orchidopexy without Division of Spermatic Vessels using a Neo- numerous procedures available to treat these patients,
inguinal Canal Approach: A Single Center Experience. World J
including staged orchidopexy, transperitoneal or
Lap Surg 2013;6(3):121-126.
retroperitoneal orchidopexy via an extended inguinal or
Source of support: Nil Pfannenstiel incision, Fowler-Stephens orchidopexy in
Conflict of interest: None declared 1 or 2 stages, microvascular transplantation and laparoscopic
World Journal of Laparoscopic Surgery, September-December 2013;6(3):121-126 121