Laparoscopic Surgery for Undescended Testis

Algorithm for management of undescended testis

Anesthesia – GA
Position of the patient – Head down
Operation Room set up (Fig. 57.1):

S

Surgeon

A

Assistant (Camera)

N

Nurse

M

Monitor

57.2.1 Ports Position

Figure 57.2 Left side orchiopexy
Figure 57.3 Right side orchiopexy
Figure 57.4 Bilateral orchiopexy

Camera port

B and C

Working ports

The mobilised testis is brought down through a tract which is created by one of the following methods.

Methods

(a)

Through the scrotal incision a trocar (10 or 12 mm) is introduced and manipulated into the inguinal canal.
(b)

Through the scrotal incision a haemostat is inserted.
(c)

Under the guidance of laparoscope an instrument is introduced through the inguinal canal into the scrotum. An incision is made in the scrotum over the instrument. This instrument guides a clamp from below into the peritoneum to bring down the testis.

57.3 Conclusion

Laparoscopy is the first step in localizing a non palpable testis or proving its absence. The testis found in inguinal canal on laparoscopic examination needs inguinal exploration or laparoscopic mobilization based on the surgeons’ choice. Single stage orchiopexy for low intra abdominal testis and two stage orchiopexy for high intra abdominal testis give good results. Bilateral undescended testes is also dealt laparoscopically on the same principles as unilateral undescended testis with distinct advantages of no additional incision or ports.