Page 16 - Laparoscopic Surgery Online Journal

Ved Bhaskar, Manash Ranjan Sahoo

(Fig. 10), and abdominal skin incision was closed with We did not have any complications intraoperatively and
ethibond so that the patient need not come back for stitch patients were discharged next day. They were followed-up
removal. In bilateral cases, one side was dealt first followed regularly. After 6 months of follow-up we did not find any
by surgery for the other side 6 months later. Postoperatively retraction of testis or any atrophy. All the testis were well
they were started with oral feed on the next day and Doppler placed inside the scrotum and of normal size and shape.
assessment of the gonadal vessels done to ensure good
vascularity to the testis before the patient was discharged. DISCUSSION
Patients were followed up after 6 months and 1 year.
The availability of a wide variety of therapeutic strategies
RESULTS to treat intra-abdominal test indicates that the ideal technique
to manage this type of pathology has not yet been found.
A total of 50 nonpalpable testes in 45 patients were taken 8
The operations available are extended groin approach,
up for diagnostic laparoscopy and and the initial inspection 9
preperitoneal exploration, two-stage or one-stage Fowler-
revealed 24 testes on right side, 16 on left and 5 cases were 10,11 12
Stephen method, microvascular transplantation and
bilateral. There were 20 testes which were in or around the 13
laparoscopic orchiopexy. Orchiopexy by high division of
internal ring while 30 were intra-abdominal with 8 testes
testicular vessels may carry a high incidence (10%) of
lying proximal to iliac vessels. Two out of this 8 were
testicular atrophy. 14 The experience with microvascular
atrophic and were found in postpubertal boys. Mean age of
autotransplantation is less and the procedure is lengthy. 12
patients was 14.5 years (8-24 years). Mean operative time
In recent years laparoscopic orchiopexy without division of
was 78 mintues (52-90 min). Surgery was considered
spermatic vessels has been taken up by many centers. 15-18
successful if the testis was in scrotum without any atrophy
The main advantages of laparoscopic orchiopexy without
after a period of minimum 6 months from surgery.
division of spermatic vessels are that testicular vessels are
We could mobilize all the 48 testes to the bottom of
scrotum in the subdartos pouch through the neo-inguinal well-preserved and mobilized for a longer length and that it
ring by the above mentioned techniques and placed them is a minimally invasive procedure.
securely without any tension. We did not require any Scrotal testis resides in a specialized low-temperature
spermatic vessel ligation or a two-stage operation even for environment with the pampiniform plexus, scrotal
testes which were located higher up, thus excluding any pigmentation, absence of subcutaneous fat. Low temperature
theoretical risk of testicular atrophy although there were is regulated by temperature-sensitive muscles–cremaster and
difficulty mobilizing them. But with meticulous dissection dartos. All these ensure decreased temperature of the gonad.
higher up in the retroperitoneum and using the new route to The scrotal testis in the human is maintained at 33ºC
scrotum which at least gives 2 to 3 cm extra by not going compared with 34ºC to 35ºC noted in the inguinal region
19
around the inferior epigastric and the inguinal canal we were and 37ºC intra-abdominally. The physiology of the testis
successful in mobilizing even difficult cases. On two is well-adapted to this lower temperature; therefore, in the
occasions we performed an orchidectomy where we found undescended testis where the ambient temperature is
20
the testis to be atrophied. increased the testis undergoes progressive alteration. Germ

Fig. 9: Testis was brought out into the scrotum Fig. 10: Testis freely lying in the newly created subdartos pouch.
Scrotal incision closed with catgut
124