Page 18 - World Journal of Laparoscopic Surgery

World Journal of Laparoscopic Surgery, January-April 2008;1(1):16-18
Sarvepalli Sudhakar, Balachandran Premkumar
Laparoscopic Management of

Undescended Testis

1 Sarvepalli Sudhakar, Balachandran Premkumar
2
1 General Surgery-registrar, Consultant General and Laparoscopic Surgeon, Apollo Hospitals, Chennai
2

Abstract: A 28-year-old male was identified to have a right sided
undescended testis, on his master health check-up. Ultrasound
examination identified the testis to be in the inguinal canal near the
deep ring. The patient was counseled of the consequences of
undescended testis in the adult and after obtaining his fully informed
consent he underwent a laparoscopic right orchidectomy and mesh
repair.
This article highlights the consequences of undescended testis, the
various modalities of investigation, treatment and also emphasizes on
the role of laparoscopy in its management.
Keywords: Undescended testis, cryptorchidism, orchidectomy,
laparoscopy.

CASE REPORT

A young software engineer attended the master health check-
up as his pre-employment requirement. His clinical examination
found the absence of the right testicle. He was not aware that
he had a problem, and mentioned that his condition was present
from birth. He was completely evaluated and his left testicle
was found to be normal. An ultrasound examination confirmed
an empty right scrotum with presence of the right testicle with Fig. 1: Ultrasound showing testis in right inguinal canal
‘altered echotexture’ in the right inguinal canal near the deep
ring (Fig. 1).
The patient was counseled and informed consent for surgery The trocars were placed as follows:
was obtained. He underwent a laparoscopic right orchidectomy • 10 mm—umbilical–camera port.
and mesh repair. During surgery his right iliac nodes were found • 5 mm—right lumbar–right hand working.
to be enlarged which were removed and sent for • 5 mm—left lumbar–left hand working.
histopathological examination. On entry into the peritoneal cavity a thorough inspection
His postoperative period was uneventful and he was of all the viscera was done. The peritoneum over the right
discharged on the first postoperative day. His sutures were inguinal region was dissected and the spermatic cord was
removed on the tenth postoperative day. identified entering into the deep ring. Traction was applied to
The histopathological findings of the testis were consistent the cord and the testis was delivered into the peritoneal cavity.
with cryptorchid testis, while the lymph nodes showed only The cord was ligated and the testis was cut and extracted
reactive changes. through an extended umbilical port. A few enlarged lymph nodes
The patient was advised to carry on routine activities and were found along the right iliac vessels which were removed
have an abdominal ultrasound once a year as follow-up. and sent for histopathology. As the right inguinal canal was
empty a mesh repair using prolene mesh was done and anchored
OPERATIVE STEPS
with tackers. The peritoneum was closed over the mesh using
Under general anesthesia, the patient was placed in the supine tackers. Pneumoperitoneum was reduced and the ports were
position. The theatre set-up was as shown in the Figure 2. closed with 1’ Vicryl; and 3’0 Monocryl.

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