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Laparoscopic Diagnosis and Treatment of Nonpalpable Testes
If a closed deep ring with blind-ending vas and vessels was Out of the 193 nonpalpable testicular units, 49 were unilateral
found, and no testicular tissue was seen on inguinal exploration, right nonpalpable testicular units, 78 left nonpalpable testicular
the testis was deemed to be vanishing and so no further procedure units, and 66 were bilateral nonpalpable testicular units before
was done. In case hypoplastic testicular vessels with vas deferens anesthesia.
enter a closed deep ring, then the testis was deemed atrophic and After laparoscopy, 111 of the 193 testicular units were found
further surgery for the removal of nubbin and the placement of to be intra-abdominal, 32 were atrophic testes, 22 were peeping
prosthesis was planned at puberty. testes, 19 were intracanalicular, and 9 were vanishing testes
When normal testicular vessels and vas deferens were found (Table 1).
entering an open deep ring, then the testis was deemed to be After the clinical examination, there were 78 patients with left
intracanalicular and an open orchidopexy was done in these patients. nonpalpable testicular units, 49 patients with right nonpalpable
When the testis was present just at the level of the deep ring and testicular units, and there were 33 patients in whom testicular units
it pops back into inguinal canal on insufflation, then it was termed could not be palpated bilaterally.
a peeping testis and an open orchidopexy was done in initial part After laparoscopy of the 78 patients with left nonpalpable testis,
of this series but later single-stage laparoscopic orchidopexy was 34 testicular units were intra-abdominal in location, 9 testicular units
done for these testes. were vanishing testis, 7 were intracanalicular, 21 were atrophic, and
In laparoscopic orchidopexy, two 5- or 3-mm secondary ports/ 7 were peeping testicular units.
direct instruments were created on both sides in the midclavicular Among the 49 patients with right nonpalpable testicular units
line at the level of the umbilicus under vision, depending on the on examination after laparoscopy, 31 testicular units were intra-
age of the patient and surgeon preference. In the case of intra- abdominal, 6 testicular units were intracanalicular, 2 were atrophic,
abdominal testes, they were divided into two groups based on and 10 were peeping testicular units.
their location relative to the deep inguinal ring and pliability of On examination, 33 patients had bilaterally nonpalpable
testicular vessels. testicular units, i.e., 66 testicular units were nonpalpable. After
In case testis located more than 2 cm proximal to the deep laparoscopy, 46 testicular units were intra-abdominal, 6 were
inguinal ring (high location) and testicular vessels were not pliable intracanalicular, 9 were atrophic, and 5 were peeping testis.
(Fig. 1), then two-stage Fowler–Stephens procedure was done Of the 78 patients with left nonpalpable testicular units, 34
laparoscopically with an interval of 6 months in between the two had intra-abdominal testes. Of these, 20 were amenable to single-
stages. Vessels were either clipped with 5-mm titanium clips or stage laparoscopic orchidopexy and 14 patients required two-
coagulated with bipolar cautery in the first stage. stage surgery. Nine patients with vanishing testis just required a
When the testis was located less than 2 cm (low location) from diagnostic laparoscopy to confirm the diagnosis. Of seven patients
the deep inguinal ring and testicular vessels were found to be
pliable, then single-stage laparoscopic orchidopexy was done.

results
One hundred and sixty patients were taken for our study after
checking the inclusion and exclusion criteria from the records
maintained. The age of surgery ranged from 9 months to 12 years.
One hundred and sixty 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 (Fig. 2).

Fig. 2: Distribution of testicular units according to a location in the
study group

Table 1: Final diagnosis depending on the location of
the testes
Location after laparoscopy Number of testes (n = 193)
Intra-abdominal 111
Vanishing 9
Intracanalicular 19
Atrophic 32
Fig. 1: Intraoperative photograph showing testis located more than
2 cm proximal to the internal inguinal ring (high location) Peeping 22

158 World Journal of Laparoscopic Surgery, Volume 14 Issue 3 (September–December 2021)