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Laparoscopic Diagnosis and Treatment of Nonpalpable Testes
inguinal ring suggest an atrophic testicular remnant, but if the in 2008. This technique allows the retention of the native blood
deep ring is patent, a normal or hypoplastic testicle is likely to supply in instances where there are doubts of vascularity with the
8
be found. Following this principle, inguinal explorations were Fowler–Stephens technique. Shehata proposes that the weight
deferred in patients with atrophic testes. of the intestines over the pedicle leads to a gradual increase in
It can be suggested that the management of nonpalpable length without spasm, intimal tear, or occlusion of spermatic
17
testes depends strongly on the initial laparoscopic findings. vessels. We are at present studying the efficacy of this new
Visualization of the vas and vessels seen to be entering the technique; however, these patients are outside the purview of
inguinal canal via the deep ring purports a groin exploration. the current series.
If only a remnant testicular nubbin is discovered, then excision
should be undertaken. Alternatively, if on laparoscopy, either the clInIcAl sIgnIfIcAnce And conclusIon
vas or the vessels stop in the abdomen or are absent or there is a
blind-ending vas without vessels, no further operative procedure We conclude that for the management of nonpalpable testes,
is necessary. If, following laparoscopy for bilateral nonpalpable laparoscopy is the gold standard. It is more cost-effective than
testes, no functioning testicular tissue is discoverable, appropriate radiological tests for the localization of intracanalicular and
counseling and endocrinological opinion need to be taken. These peeping testes that are not localized even on examination under
children will be infertile and will even require medical induction of anesthesia.
puberty. Testicular prostheses may be inserted at a postpubertal Single-stage orchidopexy is the treatment of choice for intra-
age. Sufficient length of the testicular vessels and cord should be abdominal testis lying within 2 cm from the deep inguinal ring
ensured before attempting this single-stage procedure. In patients with pliable testicular vessels, and two-stage surgery is required
with insufficient cord length and nonpliable testicular vessels, for intra-abdominal testis located beyond 2 cm from the deep
laparoscopic Fowler–Stephens orchidopexy is the procedure of inguinal ring or with nonpliable testicular vessels. However,
choice. 1 testicular placement can be suboptimal with single-stage
In some intra-abdominal testes, after distal gubernacular orchidopexy in older boys. Staged Fowler–Stephens orchidopexy
division and dissection of peritoneum, it is perfectly possible to has good results with minimal testicular loss.
do a single-stage laparoscopic orchidopexy. In an index study
after laparoscopy, 111 of the 193 nonpalpable testicular units were orcId
found to be intra-abdominal. Of these, 50 of the intra-abdominal
testes underwent a single-stage laparoscopic orchidopexy, all of Neha S Shenoy https://orcid.org/0000-0001-6725-7749
these testes were located within 2 cm from the deep inguinal ring Beejal V Sanghvi https://orcid.org/0000-0003-3969-5068
with pliable testicular vessels. This group of patients was the most Rujuta Shah https://orcid.org/0000-0002-2932-2199
benefited by laparoscopy as accurate diagnosis as well as surgical Somak K Biswas https://orcid.org/0000-0002-1143-1960
correction was achieved in the same single sitting. Ismail et al. in Sandesh V Parelkar https://orcid.org/0000-0002-9292-7270
their study did single-stage laparoscopic orchidopexy successfully
in 26 testes of the 75 nonpalpable testes. 4
Sixty-one of the intra-abdominal testes in our study were references
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160 World Journal of Laparoscopic Surgery, Volume 14 Issue 3 (September–December 2021)