ABSTRACT
To show the advantages and limitations of laparoscopy in management of the non-palpable testis. Herein, we report our experience with diagnostic and interventional laparoscopic procedures in children with non-palpable testes. Between 1997 and 2001, 28 children underwent 30 laparoscopic procedures for evaluation and management of 36 non-palpable testes. Pneumoperitoneum was achieved using a Veress needle inserted infraumbilically in all cases. Examination of the abdomen and pelvis was performed with a 30°, 5 mm laparoscope. When intervention was deemed necessary, 2 to 3 additional 5 mm ports were inserted under direct visual control. For dissection, laparoscopic microscissors and electrosurgical dissection were used. The mean patient age was 3.6 years [12 months -14 years]. A total of 12 diagnostic procedures [localization] were performed on 12 patients and 15 inguinal exposures were done based on the laparoscopic findings [14 orchiopexy and 1 orchiectorny]. Tlie testes were absent in six more patients and farther surgery avoided. Twelve laparoscopic interventions were done on 10 patients: 9, one stage laparoscopically assisted orchiopexy, 1, two-staged orchiopexies, 1, laparoscopic Fowler-Stephen orchiopexy and, laparoscopic orchiectcmy. All procedures were performed on outpatient basis or with an overnight stay. There were 4 complications: injury of the spermatic vessels which did not affect the viability of the testis in one instance, two testes had atrophied at 4 weeks and 6 weeks follow-up, and one testis had retracted to the level of the pubic tubercle at 9 months. Laparoscopy is a useful tool in the management of the non-palpable testes. For an intracanalicular testis, an inguinal orchiopexy is recommended. For intra-abdominal testes, a laparoscopic orchiopexy is the technique of choice at our institution