V7-06 PERCUTANEOUS EXTERNALLY ASSEMBLED LAPAROSCOPIC (PEAL) SURGERY FOR FOWLER-STEPHENS ORCHIOPEXY: A VIDEO PRESENTATION

Abstract

INTRODUCTION AND OBJECTIVES: Laparoscopy is the gold standard for diagnosis and treatment of boys with non-palpable testicles. In an effort to reduce the invasiveness of laparoscopic orchiopexy, various strategies have been employed including use of laparoendoscopic single site surgery (LESS) and needlescopic surgery. Needlescopic instruments have limited functionality due to their small size and are more prone to intrabdominal organ injury. LESS has been criticized when used in children due to the requirement of a much larger 3 cm incision. In this video we will demonstrate the feasibility of a novel percutaneous externally assembled laparoscopic (PEAL) surgery paradigm for orchiopexy which is designed to reduce the invasiveness of the procedure while maintaining instrument triangulation. METHODS: The PEAL surgical paradigm is composed of a reusable handpiece and a disposable 2.96 mm instrument shaft and interchangeable disposable 5 mm instrument tips. This video will demonstrate how the PEAL instruments are externally assembled and brought back into the abdomen without a trocar to perform the surgery. Due to their small size and because they are assembled externally, they produce an essentially scarless outcome. This video will demonstrate the PEAL surgical paradigm for the performance of Fowler-Stephens orchiopexy. RESULTS: Using this innovative new paradigm, a 9 month-old infant underwent first stage and a 9 year-old child underwent second stage successful bilateral Fowler-Stephens orchiopexies. Operative times were 65 minutes for the first stage and 180 minutes for the second stage. Blood loss was minimal in both cases. Both patients were discharged the day of surgery with no complications. At follow up, the objective cosmetic results were excellent and the second patien's testis was palpable in the scrotum and well-positioned. CONCLUSIONS: Due to its improved cosmesis and ease of performance, the PEAL surgical paradigm shows promise in reducing the invasiveness of pediatric Fowler-Stephens orchiopexy. In addition it shows promise with a wide variety of minimally invasive surgical applications.