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ORIGINAL ARTICLE
Laparoscopic Diagnosis and Treatment of Nonpalpable Testes

in a Tertiary Care Center

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Neha S Shenoy , Beejal V Sanghvi , Rujuta Shah , Somak K Biswas , Sandesh V Parelkar 5
AbstrAct
Background: Cryptorchidism is the commonest genitourinary anomaly in boys. Laparoscopy has been the mainstay for the management of
nonpalpable testis.
Aim and objective: This study has been done to assess the role of laparoscopy in diagnosing and treating nonpalpable testes.
Materials and methods: Medical records of 160 patients of laparoscopic testicular exploration, during a 10-year period, were retrospectively
analyzed. All 160 boys with 320 testicular units were examined prior to surgery—118 of the 320 testicular units were normally descended (37%),
9 had palpable undescended testicular units (3%), and 193 testicular units (60%) were nonpalpable.
Results: After laparoscopy, 111 of the 193 nonpalpable testicular units were found to be intra-abdominal, 32 were atrophic testes, 22 were
peeping testes, 19 were intracanalicular, and 9 were vanishing testes. Of the 111 intra-abdominal testicular units according to the location
in relation to the deep inguinal ring, 51 of the testicular units were located within 2 cm from the deep inguinal ring. Among these, 49 cases
underwent single-stage laparoscopic orchidopexy and 2 patients required laparoscopic mobilization followed by open orchidopexy due to long
loop vas. Sixty testicular units were found greater than 2 cm from the deep inguinal ring and were managed by two-stage Fowler–Stephens
laparoscopic orchidopexy.
Conclusion and clinical significance: Laparoscopy is safe and effective in managing nonpalpable testis. Single-stage orchidopexy is the treatment
of choice for intra-abdominal testis located within 2 cm from the deep inguinal ring with pliable testicular vessels and two-stage surgery is
required for intra-abdominal testis located more than 2 cm from the deep inguinal ring and with nonpliable testicular vessels.
Keywords: Laparoscopy, Nonpalpable testes, Testicular units, Undescended.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1476

IntroductIon 1 Department of Paediatric Surgery, TNMC and BYL Nair Hospital,
Undescended testis is a common condition referred to pediatric Mumbai, Maharashtra, India
surgeons, as cryptorchidism is the most common genitourinary 2,3,5 Department of Paediatric Surgery, Seth GS Medical College and
anomaly in boys. It is found in 3% of full-term neonates, rising to KEM Hospital, Mumbai, Maharashtra, India
30% with prematurity. About 20% of maldescended testes are 4 Department of Paediatric Surgery, Institute of Child Health, Kolkata,
1–3
nonpalpable. Management of nonpalpable testis provides many West Bengal, India
challenges from accurate localization to successful repositioning Corresponding Author: Beejal V Sanghvi, Department of Paediatric
of the testicular units. Laparoscopy has been found to be a useful Surgery, Seth GS Medical College and KEM Hospital, Mumbai,
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tool in both these aspects. The aim of our study was to assess and Maharashtra, India, Phone: +91 9833452626, e-mail: beejalsanghvi@
discuss the role of laparoscopy in managing nonpalpable testis. gmail.com
How to cite this article: Shenoy NS, Sanghvi BV, Shah R, et al.
MAterIAls And Methods Laparoscopic Diagnosis and Treatment of Nonpalpable Testes in a
Tertiary Care Center. World J Lap Surg 2021;14(3):157–161.
We retrospectively reviewed documents of all children below Source of support: Nil
12 years of age undergoing laparoscopy for nonpalpable testis Conflict of interest: None
over a study period of ten years after getting institutional
ethical committee clearance. All boys with undescended testes
presenting to the outpatient clinic were examined for palpability and was therefore excluded from the study sample. In case the testis
of testis. Children with palpable undescended testicular units was not palpable, we proceeded with laparoscopy.
were posted for open orchidopexy through an inguinal incision A 5-mm port was inserted by open technique for the telescope
and not considered in this study. If the testis was not palpable, via a subumbilical curved incision. We used a 5-mm 30° telescope
an ultrasound of the abdomen and inguinoscrotal region was for all cases. Pneumoperitoneum was created and diagnostic
performed and the child was posted for orchidopexy, once older laparoscopy was conducted to locate the testis and to note its
than 6 months. Possibility of different findings and procedures was size, any abnormalities, distance from the deep inguinal ring
always discussed with parents prior to the surgery. and iliac vessels, pliability of testicular vessels, presence of an
A careful physical examination under general anesthesia was open deep inguinal ring, and the presence of a long loop of vas
always performed in the operating room prior to laparoscopy. If the deferens entering the deep ring. Further procedure was decided
testis was palpable, the child was operated on by open technique accordingly.

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