Laparoscopic treatment of non-palpable testis

Abstract

There is a variety of therapeutic strategies for the management of non-palpable testes. The surgeon can easily select the most appropriate one based on the laparoscopic findings (Vaysse 1994): In case of blind-ending cord structures: no surgical exploration is necessary (Andze et al. 1990). In case of cord structures entering the internal inguinal ring: open inguinal exploration may be required to identify and remove, if necessary, an atrophic intracanalicular or ectopic testis. The policy of always performing a surgical exploration, when cord structures enter the internal inguinal ring, based on the fear of malignant degeneration of the remaining testicular tissue is questionable. In fact malignant degeneration of such remaining tissue is very rarely reported in the literature (Esposito et al. 2000). In case of an atrophic intra-abdominal testis: a laparoscopic orchiectomy can be performed using clips or simply electrocoagulation (Jordan 1997). Concerning the optimal surgical treatment of an intraabdominal testis (IAT), there is no general agreement. Some surgeons prefer to perform an orchidopexy using open surgery, others use microsurgery, but the majority of pediatric surgeons prefer to perform a laparoscopic orchidopexy in case of IAT (Baker et al. 2001). The main point of discussion in laparoscopic orchidopexy is whether or not the spermatic vessels should be divided or whether they can be spared (Flett et al. 1999). As a matter of fact, there are two main procedures that have been adopted to perform laparoscopic orchidopexy in case of IAT: 1. The Fowler-Stephens (FS) procedure, in which the spermatic vessels are divided. This can be done in one or two steps 2. The laparoscopic-assisted orchidopexy (LAO) where the orchidopexy is performed without sectioning of the spermatic vessels. Another option, which allows 1 or 2 cm of length to be gained, consists of the creation of a neoinguinal ring medially to the epigastric vessels. This option can be adopted in both the FS procedure and the LAO (Esposito et al. 2002). © Springer-Verlag Berlin Heidelberg 2008.