Page 20 - World Journal of Laparoscopic Surgery

Sarvepalli Sudhakar, Balachandran Premkumar

vessels confirms an absent testis, allowing termination of the 3. Deans GT, O’Reilly PH, Brough WA. Laparoscopy for
procedure without a groin incision. If vessels and vas deferens undescended testis: embryological considerations. Br J Urol
exit the internal ring, the groin can be explored. If an intra- 1995;76:806-7.
abdominal testis is identified, the physician can then choose 4. Desai CS, Prabhu RY, Supe AN. 25-6, 48, 2002, JPGM.
the best surgical approach. 12 5. Docimo S. Improved technique for open laparoscopic access. J
Laparoscopy is the modality of choice for cryptorchid Endourol 1998;12:S185.
13
children. In majority of adult patients cryptorchid testis is 6. Lojanapiwat B, Soonthornpun S, Wudhikarn S. Preoperative
laparoscopy in the management of the nonpalpable testis. J
intra-abdominal either at the deep ring or high intra-abdominally. Med Assoc Thai 1999;82:1106-10.
Laparoscopy obviates the need of unnecessary inguinal 7. Pinczowski D, McLaughlin JK, Lackgren G, Adami HO, Persson
exploration and disrupting normal inguinal canal mechanism. If I. Occurrence of testicular cancer in patients operated on for
attenuated testicular vessels are noted entering inguinal canal, cryptorchidism and inguinal hernia. J Urol 1991;146:1291-4.
then inguinal exploration is indicated. However, in cases of 8. Pyorala S, Huttunen NP, Uhari M. A review and meta-analysis
blind ending vas, when there is no inguinal hernia, laparoscopy of hormonal treatment of cryptorchidism. J Clin Endocrinol
can be safely used with the deep ring occluding mesh plug. 4 Metab 1995;80:2795-9.
9. Rajfer J, Walsh PC. The incidence of intersexuality in patients
CONCLUSION with hypospadias and cryptorchidism. J Urol 1976;116:769-
70.
Laparoscopy remains the modality of choice in the diagnosis 10. Riegler HC. Torsion of intra-abdominal testis: an unusual problem
12
and surgical management of adult cryptorchidism. Its minimal in diagnosis of the acute surgical abdomen. Surg Clin North Am
invasiveness combined with excellent imaging obviates the need 1972;52:371-4.
for costly investigations like MRI and CT scan and prevents 11. Schultz KE, Walker J. Testicular torsion in undescended testes.
unnecessary inguinal exploration and laparotomy. 5, 6 Ann Emerg Med 1984;13:567-9.
12. Sexton WJ, Assimos DG. Diagnostic and therapeutic laparoscopy
for the adult cryptorchid testicle. Tech Urol 1999;5:24-8.
REFERENCES 13. Silver RI, Docimo SG. Cryptorchidism. In Gonzales ET, Bauer
1. Colodny AH. Undescended testes—is surgery necessary? SB, (Eds): Pediatric urology practice. Philadelphia: Lippincott-
[Editorial]. N Engl J Med 1986;314:510-1. Raven, 1999;499.
2. Cortesi N, Ferrari P, Zambarda E, Manenti A, Baldini A, Morano
FP. Diagnosis of bilateral abdominal cryptorchidism by
laparoscopy. Endoscopy 1976;8:33-4.

18