Early Experience with Laparoscopic Surgery for Undescended Testis at a Tertiary Hospital in Ibadan (2015-2019)

Background: Undescended testis (UDT) is of concern to the patient. If not treated may be complicated by trauma, torsion, male sub-fertility, and testicular cancer. In Nigeria it is commonly treated by open orchidopexy or orchidectomy. We report our experience with the laparoscopic management of undescended testes in the Western part of Nigeria. Methodology: The aim of this study was to report our early experience with the laparoscopic treatment of undescended testis in our centre. The study was conducted between January 2015 and December 2019. The data studied were age, unilateral or bilateral UDT, operation performed, pre-and intra-operative findings, operation time, and the outcome. The data were represented in tables and with operative pictures. Ethical clearance was obtained. Results: A total 12 patients were treated which consisted of 7 children and 5 adults with a mean age of 11 (6-17) years and 35.2 (29-42) years respectively. Preoperatively, 9 patients had transperitoneal laparoscopic orchidopexy, orchidectomy or varicocelectomy. The laparoscopic findings were peeping testis (5), intraabdominal testis (8), intracanalicular (5), and one absent testis. All the post-orchidopexy testes remained in the scrotum at 18 months of follow up. In the adults, there was improvement in the semen parameters in 2 men while 3 had persistent azoospermia. Conclusion: In our setting, laparoscopy for undescended testis is feasible, safe, diagnostic, and therapeutic. In infertile men with undescended testis and unilateral varicocele, laparoscopic varicocelectomy results in improved semen quality.

Laparoscopic orchiopexy versus traditional inguinal incision orchidopexy for palpable undescended testes in cryptorchidism

Background ： Laparoscopic orchidopexy (LO) has become a standard procedure for the treatment of nonpalpable undescended testes. Nevertheless, the use of LO for palpable undescended testes still remains controversial. The aim of this study was to explore the impact of laparoscopic orchiopexy procedure on palpable undescended testes in children suffering from cryptorchidism. Methods: A retrospective study was performed for LO and traditional inguinal incision orchidopexy (TIO) carried out to treat palpable undescended testes. In total, 291 children aged 9 months to 96 months with either left or right side palpable inguinal canalicular testes were included. 170 patients received LO and 121 patients received TIO. Age, operative time and clinical outcomes of the patients were reviewed. Independent t test and Fisher’s exact test were performed by using the SPSS 25.0 software. Results: In the younger groups, the mean operative time (younger than 1 year old, 30.50±5.88 vs. 39.86±6.11 min; 1-2 years old, 34.43±6.65 vs. 40.23±8.74) and postoperative normal activity time (younger than 1 year old, 1.20±0.40 vs. 2.12±0.48 days; 1-2 years old, 1.58±0.50 vs. 2.02±0.43 days) of LO were significantly shorter than those in the TIO group ( P <0.05). The operative time of LO was significantly longer than that in the TIO group in older groups (aged>3 years old). 47 of 49 cases (95.9%) of patients aged less than 1 year old were treated by LO successfully. Among the patients aged 1-2 years, 80 of 86 cases (93.0%) successfully completed LO. Totally, 43 cases were transferred to inguinal incisions. Conclusion: LO is an appropriate choice for palpable undescended testes, especially in children younger than 2 years old. The percentage of successful LO decreased with the increasing age.

Laparoscopy and the impalpable testes: diagnosis, treatment options and the literature

Background: Laparoscopy is the best available tool and method to manage impalpable undescended testes; management of the impalpable testis often pose a significant diagnostic and therapeutic challenge to a surgeon. The aim of this work was to elucidate and present the sensitivity and the value of laparoscopy, as a surgeon’s tool, for the diagnosis and treatment of the impalpable testis.Methods: From November 2015 to December 2018, 56 patients with 60 impalpable testes were operated upon by laparoscopic approach by a single surgeon. One-stage Fowler-Stephens laparoscopic orchidopexy was performed in 14 cases, while two-stage Fowler-Stephens laparoscopic orchidopexy was performed in 16 cases and Vessel-Intact Laparoscopic Orchidopexy (VILO) was done in 22 cases. In 2 cases vessel and vas was entering through deep ring and inguinal orchidopexy was done. Blind ending vessel/vas was noticed in 4 cases (vanishing/absent testes). Laparoscopic orchidectomy was required in 2 patients for nubin. No case of disorder of sexual dysfunction was (DSD) was found.Results: Laparoscopy was successfully completed in all the cases. 34 testicles were impalpable on right side, 18 on left side and other 4 cases (8 testicles) were bilaterally impalpable. Laparoscopic orchidopexy was carried out for 36 testes at the same. 16 needed a staged procedure. Orchidectomy was done in 2 cases/testes. In 4 cases testes was absent/vanishing. In 2 cases testes was canalicular, standard inguinal orchidopexy was done. The mean operative time was 48 minutes. Patients were allowed oral fluids 6 hours of the operation and were discharged at one day after the procedure. None of the patients had wound infection. Patients were followed up for a mean period of 12 months. At follow-up, all but one of the testes were well down in the bottom of the scrotum. In one patient, the testis was in a high scrotal position. All testes were of normal size, no atrophy was seen so far and no malignant change is suspected in any case so far. No severe morbidity or death was observed in our study.Conclusions: Laparoscopy offers surgeons a safe and reliable diagnostic and therapeutic option to patients with impalpable testes. No other imaging investigation is required, if well versed with basic laparoscopy. Intra-abdominal dissection allows more testes to be brought down to the scrotum. Even when open orchidopexy is being done for intra-canalicular testes in a child, it is advisable to be ready with laparoscopy if necessary, at the same time, in case open surgery fails to mobilize the testicular vessels adequately. The procedure is best viewed as laparoscopy-assisted; as Orchidopexy has to be done in a conventional manner.

Laparoscopic orchidopexy and its outcome in the management of nonpalpable testis

Background: Management of impalpable testis represents a significant diagnostic and operative challenge. The aim of this work was to present the superior value of laparoscopy as a single tool for the diagnosis and treatment of impalpable testis.Methods: 51 patients with 58 nonpalpable were included in our study. Study design was case series. We have conducted this study at Surat Municipal Institute for Medical Education and Research, Surat. For each patient laparoscopy orchidopexy was performed and either testis or blind ending cord structure are searched for. The testis either brought down to the scrotum or removed depending on the condition. The patients were followed up for 12 months.Results: On diagnostic laparoscopy the number of testis found normal 54, followed by 3 hypoplastic and 1 atrophic. There were 8 testis found to be present at high intraabdominal (>2 cm from deep ring), 46 were present at low intra-abdominal (<2 cm from deep ring), intracanalicular 4. Postoperative complication included minor wound infection in one patient, none of them were diagnosed scrotal hematoma, port site hernia, and testicular atrophy.Conclusions: Laparoscopy seems to offer a safe and reliable diagnostic and therapeutic option to patients with nonpalpable testis. Intraabdominal dissection allows more testis to be brought down to scrotum. Laparoscopy clearly demonstrate the anatomy and provide visual information upon which a definitive decision can be made.

A comparative study of transscrotal, transinguinal and laparoscopic orchidopexy for inguinal cryptorchidism

Background A retrospective comparative study was performed on scrotal incision, inguinal incision and laparoscopic orchidopexy. The characteristics of the different surgical methods were analysed. Methods Clinical data of 158 patients with inguinal cryptorchidism admitted to our hospital from January 2017 to January 2018 were retrospectively analysed. Results The operation time in the scrotal incision group was significantly less than that in the inguinal incision group and laparoscopic group (P < 0.05). The length of the operative incision in the scrotal incision group and laparoscopic incision group was shorter than that in the inguinal incision group. There was no significant difference in the postoperative hospitalisation time or hospitalisation cost among the three groups (P > 0.05). The incidence of scrotal haematoma in the scrotal incision group was significantly higher than that in the inguinal incision group and laparoscopic group. There were no complications, such as testicular atrophy, testicular retraction, indirect inguinal hernia, or hydrocele. Conclusions Transscrotal incision, transinguinal incision and laparoscopic orchidopexy are safe for the treatment of inguinal cryptorchidism. Satisfactory early clinical results can be achieved. Rational use of scrotal incision surgery and laparoscopic surgery for cryptorchidism may replace transinguinal surgery and can provide a good cosmetic effect for children.

Comparison of Laparoscopic Orchiopexy and Traditional Inguinal Incision Orchidopexy for Palpable Undescended Testes in Cryptorchidism

Background Laparoscopic orchidopexy (LO) has become a standard procedure for the treatment of nonpalpable undescended testes. LO for palpable undescended testes is still controversial. The aim of this study is to explore the method and effect of laparoscopic orchiopexy procedure for palpable undescended testes in children suffering from cryptorchidism.Methods A retrospective study was performed for LO and traditional inguinal incision orchidopexy(TIIO) for palpable undescended testes. Totally 220 children age ranged from 9 months to 96 months with both palpable inguinal canalicular testes were included. 170 patients received LO and 50 patients received TIIO. Patient age, operative time and clinical outcomes were reviewed. Independent t test and Fisher’s exact test were performed by SPSS 25.0 software.Results The mean operative time (30.77 ± 6.02 vs 44.76 ± 6.70 min), postoperative normal activity time (1.25 ± 0.43 vs 2.48 ± 0.68 day) of LO was significantly shorter than TIO group. (P < 0.05). 47 of 49 cases (95.9%) within 1-year-old were successfully achieved LO.Conclusion LO is an appropriate choice for palpable undescended testes, especially in younger children within one-year-old. The successful percentage of LO decreased with age growing.

Laparoscopic management of non-palpable un-descended testes: our experience

Background: The purpose of the study was to determine the sensitivity and specificity of laparoscopy in localizing non-palpable testes, its therapeutic role, mean operative time, conversion rate, complications and hospital stay.Methods: A total of 52 patients were included in the study and was conducted from June 2012 to June 2017. These boys were examined as outpatients, at the time of admission and after general anesthesia to exclude palpable testes and were subjected to diagnostic and operative laparoscopy.Results: We identified 52 patients with 66 non palpable un-descended testes. The most common age of presentation was 1-4 years. Majority of patients i.e. 27 were on the left side. Ultra-sound identified testis >2 cm from deep inguinal ring in 20, near deep ring <2 cm in 20 and at inguinal canal in 6 patients. In the diagnostic laparoscopy, high intra-abdominal testis found in 34, low intra-abdominal testis in 24, blind ending of vas and vessels in 2 patients. The operative procedures performed are diagnostic laparoscopy, laparoscopic orchidopexy, laparoscopic orchidectomy, conversion to open orchidopexy and open orchidectomy. The mean operative time was 53.67±2.37 for unilateral and 102.76±5.38 for bilateral cases. The postoperative complications include surgical emphysema, wound infection and scrotal haematoma. The mean hospital stay was 14.23±2.37 hours for unilateral and 16.27±5.38 hours for bilateral.Conclusions: Laparoscopic orchidopexy appears to be a feasible, minimally invasive, less postoperative pain and trauma, faster convalesce and return to normal activity and an effective technique for the management of low intra-abdominal testes.

Undescended Testes and Laparoscopy: Experience from the Developing World

Background. Cryptorchidism or undescended testes is the most common disorder of the male endocrine glands in children. With the advancements in laparoscopic techniques and instruments, laparoscopic orchidopexy has become the standard procedure in the management of nonpalpable undescended testes. Aim. To evaluate and determine the therapeutic role, sensitivity, and specificity of laparoscopy in localizing nonpalpable testes and the mean operative time, the conversion rate (and reasons thereof), postoperative wound infection, postoperative stay, and time taken for return to daily activities following laparoscopic orchidopexy or orchidectomy. Materials and Methods. This was a prospective study carried out in the Postgraduate Department of Surgery, Government Medical College, Srinagar, J&K, India, from May 2008 to August 2011. All patients who presented to the outpatient department with complaints of absent testes were examined, and the ones with nonpalpable testes were included in the study. Results. The mean operative time for bilateral and unilateral nonpalpable testis was 102.76 and 53.67 minutes, respectively. Minor postoperative wound infections were noted in 4 of our patients. Mean duration of hospital stay was 14.23 hrs for unilateral cases and 16.27 hrs for bilateral cases. Patients who underwent laparoscopic orchidopexy resumed their normal activities within 4 ± 1 days. Conclusion. Laparoscopy clearly demonstrates the anatomy and provides visual information upon which a definitive decision can be made for further management of the undescended nonpalpable testis.