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Gopinathan A, Ramachandran B, Ramalingam S, Kannan P. Laparoscopic totally extraperitoneal exploration of intra-abdominal testis, orchidectomy and inguinal hernia repair in an adult patient. BMJ Case Rep 2023; 16:e255925. [PMID: 37989333 PMCID: PMC10668141 DOI: 10.1136/bcr-2023-255925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
The presence of undescended testis predisposes to the development of an inguinal hernia due to the persistent processus vaginalis. This coexistence is not very rare in the paediatric population. Here, we report an adult man who presented with inguinal hernia and an intra-abdominal testis and successfully underwent an extended totally extraperitoneal (e-TEP) approach for extraperitoneal exploration of the testis in the left iliac fossa, and orchidectomy along with inguinal hernia repair. Review of the literature revealed only two case reports in which TEP has been used in the treatment of undescended testis in adults, and in both cases, the testes were intracanalicular. This case, as per our extensive bibliographical research, is the first reported case of an intra-abdominal testis, with descent arrested at the iliac fossa, explored using e-TEP along with inguinal hernia repair. Such minimally invasive procedures may be offered to the patients without the risks of intraperitoneal entry.
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Affiliation(s)
- Athira Gopinathan
- General Surgery, SRM Medical College Hospital and Research Centre, Kancheepuram, Tamil Nadu, India
| | - Balamurugan Ramachandran
- General Surgery, SRM Medical College Hospital and Research Centre, Kancheepuram, Tamil Nadu, India
| | | | - Padma Kannan
- General Surgery, SRM Medical College Hospital and Research Centre, Kancheepuram, Tamil Nadu, India
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Liu J, Tang R, Wang X, Sui B, Jin Z, Xu X, Zhu Q, Chen J, Ma H, Duan G. Comparison of Two Types of Staged Laparoscopic Orchiopexy for High Intra-Abdominal Testes in Children: A Retrospective Study From a Single Center. Front Pediatr 2021; 9:677955. [PMID: 34222147 PMCID: PMC8247650 DOI: 10.3389/fped.2021.677955] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To evaluate the efficacy and safety of 2nd-stage laparoscopic traction orchiopexy (Shehata technique) compared to Fowler-Stephens (F-S technique) for high intra-abdominal testes (IATs) in children. Patients and Methods: We performed a retrospective review of all children (<14 years old) who underwent laparoscopic treatment of high IAT in the pediatric surgery center of Yijishan Hospital of Wannan Medical College from April 2016 to April 2020. Participants were divided into the Fowler-Stephens (F-S) group and Shehata group according to the surgical method. We collected the medical records of all children and analyzed them statistically. Results: In this study, 43 patients in our center received 2nd-stage laparoscopic surgical treatment. The results showed that there were 23 high IATs in 22 patients in the F-S group and 22 IATs in 21 patients in the Shehata group. All patients completed the operation successfully. No significant difference in operation time was noted between the two groups. There was no significant difference in the testicular atrophy rate between the two groups (P = 0.323). The testicular retraction rate of the F-S group was greater than that of the Shehata group (P = 0.04). Conclusion:The results of this study indicate that the application of assisted laparoscopic testicular traction technology can effectively retain the main blood supply of the testis and vas deferens with a high survival rate and clear advantages. The preliminary results show that the Shehata technique is safe, reliable and effective in the treatment of high IAT in children.
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Affiliation(s)
- Jie Liu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Rui Tang
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Xiao Wang
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Bangzhi Sui
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Zhiyuan Jin
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Xudong Xu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Qinghua Zhu
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Jin Chen
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Honglong Ma
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
| | - Guangqi Duan
- Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, China
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Ekwunife OH, Modekwe VI, Ugwu JO, Ugwunne CA. Early Experience with Laparoscopic Management of Nonpalpable Undescended Testes. Niger J Surg 2017; 23:115-118. [PMID: 29089736 PMCID: PMC5649426 DOI: 10.4103/njs.njs_59_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Nonpalpable undescended testes (NPT) constitute 20%–30% of undescended testes, and its management has been a challenge both in diagnosis and treatment. Worldwide, laparoscopy is the current gold standard of management. In Nigeria, the management of NPT has largely been by open surgery with consequent high morbidity. In Nigeria, the trend is changing from a largely open management with its attendant high morbidity, to laparoscopic management which is the current worldwide gold standard of care. Aim: This study aims to classify the laparoscopic features of NPT and determine the outcome of managed cases in our center. Methodology: Prospective data were collected from consecutive patients who had laparoscopy for NPT at the Paediatric Surgical Unit of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria from June 2014 to July 2016. Results: A total of 15 patients with 23 testes were treated. There were eight patients with bilateral NPT; four had left and the remaining three right NPT. The age ranged from 1.2 to 29 years with a median of 5 years. Eleven out of the 22 internal inguinal rings were open. The position of the testes was canalicular (2), peeping (2), low abdominal (6), high abdominal (6), blind-ended vas (1), absent vas and vessels (5). No further intervention was needed for the six agenetic/atrophic testes. Standard open orchiopexy was done for the two canalicular testes. Eight testes were brought down by one stage laparoscopic orchiopexy while four were brought down by staged laparoscopic Fowler-Stephens procedure. Laparoscopic orchiectomy was done in two patients (a grossly dysmorphic testes [nubbin] and a high abdominal testis in a 29-year-old). Orchiopexy was successful in 11 out of 15 fixed testes. Of the unsuccessful ones, three testes were atrophic (volume less than what it was initially) while two were high scrotal (one testes has both complications). There was no conversion to open abdominal surgery. All patients were discharged within 24 h of surgery. Conclusion: Laparoscopy provides for a better management of NPT by combining diagnosis and intervention in the same sitting with a good success rate and minimal postoperative morbidity.
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Affiliation(s)
- Okechukwu Hyginus Ekwunife
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, PMB 5025, Nnewi, Anambra State, Nigeria
| | | | - Jideofor Okechukwu Ugwu
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, PMB 5025, Nnewi, Anambra State, Nigeria
| | - Chuka Abunike Ugwunne
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, PMB 5025, Nnewi, Anambra State, Nigeria
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Treatment of impalpable testis - one clinic's experience. Wideochir Inne Tech Maloinwazyjne 2017; 12:166-171. [PMID: 28694903 PMCID: PMC5502339 DOI: 10.5114/wiitm.2017.67482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/26/2017] [Indexed: 11/29/2022] Open
Abstract
Introduction Undescended testes are recognised in 1% to 2% of boys during the first year of life, and about 20% of them are impalpable. Ultrasonography (US) may establish the localisation of the testis but the final diagnosis is usually determined laparoscopically. Aim To evaluate long-term results of laparoscopic treatment of boys with impalpable testes and sensitivity of preoperative ultrasound. Material and methods Between 2011 and 2015, we operated on 545 boys with undescended testes. Sixty-two of them with 65 impalpable testes were treated laparoscopically – the study group. Mean age was 3.5 years. The study group was divided into 5 groups according to type of treatment. The volume and position of the operated gonad were assessed manually and by ultrasound. Results In group 1 testicular agenesis was observed in 19 patients. In group 2 revision of the inguinal canal revealed testicular agenesis in 7 and atrophy in 4 patients. In group 3 conversion to classic orchiopexy was performed in 10 patients. In group 4 one-stage orchiopexy was performed in 9 patients on 12 testes. In group 5 a two-stage F-S procedure was performed in 13 patients. Ten testes in group 4 had a volume in the normal range (84%) and also 10 testes in group 5 (77%). Conclusions Laparoscopy in impalpable testes is the procedure of choice and allows definitive management, even when conversion to open procedure is necessary. Sensitivity of preoperative ultrasound is generally about 60% for true intra-abdominal testes, so diagnostic laparoscopy is necessary.
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Abstract
PURPOSE While the nonpalpable testis represents a small portion of all cryptorchid testes, it remains a clinical challenge for pediatric urologists. Controversy exists surrounding the best evaluation and management of this entity. In this review we update what is known about the nonpalpable testis, including the etiology, preoperative evaluation and best surgical management as well as novel techniques and ongoing controversies. MATERIALS AND METHODS We searched PubMed® and MEDLINE® from January 2000 to January 2017 using relevant key terms. Of 367 articles 115 were considered for inclusion based on a priori design. Using a narrative review format, an update on the evaluation and management of the nonpalpable testis including novel concepts and techniques was synthesized. RESULTS The nonpalpable testis should be evaluated by physical examination only. Imaging is not indicated for routine cases. The optimal surgical approach and technique remain debatable but several novel techniques have been described. Due to the rarity of the nonpalpable testis, randomized controlled trials and other quality comparisons are difficult. Therefore, management remains controversial. CONCLUSIONS Evaluation and management of the nonpalpable testis remain difficult, and some aspects are still debated. Future research should focus on multi-institutional collaborative trials to determine the optimal operative management.
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Affiliation(s)
| | - Kate H Kraft
- Department of Urology, University of Michigan, Ann Arbor, Michigan
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Naycı A, Bahadır GB, Erdoğan C, Taşkınlar H. Laparoscopic one-stage Fowler-Stephens orchiopexy preserving gubernaculum. Turk J Urol 2017; 43:75-78. [PMID: 28270955 DOI: 10.5152/tud.2016.32392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 09/06/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess gubernaculum-sparing laparoscopic one-stage Fowler-Stephens orchiopexy (FSO), in the management of high intrapelvic testis. MATERIAL AND METHODS Medical reports of boys who underwent laparoscopic one-stage FSO were retrospectively reviewed. High intrapelvic testis was defined as testis ≥3 cm away from ipsilateral internal ring. Testes were evaluated on physical examination at 3rd, 6th and 18th months after surgery. Children were evaluated as for their demographic data, operative findings, interventional details and outcomes. RESULTS Seven patients met inclusion criteria of the study. Six of 7 testis were small and had abnormal appearance, compared with the contralateral testis. Average distance of the testes from the internal ring was 4.2±1.1 cm (3 to 6). Average age at surgery was 6.1±4.2 years (2 to 12). Average follow-up period was 14±5.8 months (8 to 20), and 5 testis (71.4%) were considered to be normal in volume and scrotal location. Two testes were relatively atrophic and underwent orchiectomy. CONCLUSION Our preliminary results shows a good testicular survival rate for one-stage laparoscopic FSO. Sparing collateral vasculature of the gubernaculum is important.
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Affiliation(s)
- Ali Naycı
- Department of Pediatric Surgery, Mersin University School of Medicine, Mersin, Turkey
| | | | - Cankat Erdoğan
- Department of Pediatric Surgery, Mersin University School of Medicine, Mersin, Turkey
| | - Hakan Taşkınlar
- Department of Pediatric Surgery, Mersin University School of Medicine, Mersin, Turkey
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Chan KWE, Lee KH, Wong HYV, Tsui SYB, Wong YS, Pang KYK, Mou JWC, Tam YH. Use of laparoscopy as the initial surgical approach of impalpable testes: 10-year experience. World J Clin Pediatr 2015; 4:155-159. [PMID: 26566489 PMCID: PMC4637807 DOI: 10.5409/wjcp.v4.i4.155] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/23/2015] [Accepted: 08/14/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the experience in the management of impalpable testes using laparoscopy as the initial approach and the need for inguinal exploration.
METHODS: From January 2004 to June 2014, 339 patients with undescended testes underwent operation in our institute. Fifty patients (15%) had impalpable testes. All children with impalpable testes underwent initial laparoscopy. A retrospective review was conducted on this group of patients and the outcome was analyzed.
RESULTS: Forty children had unilateral impalpable testis. Ten children had bilateral impalpable testes. Thirty-one children (78%) in the unilateral group underwent subsequent inguinal exploration while 4 children (40%) in the bilateral group underwent inguinal exploration (P < 0.05). Orchidopexy was performed in 16 children (40%) in the unilateral group and 9 children (90%) in the bilateral group (P < 0.05). Regarding the 24 children with unilateral impalpable testis and underwent orchidectomy for testicular nubbin (n = 19) or atrophic testes (n = 2) or has vanishing testes (n = 3); contralateral testicular hypertrophy was noticed in 10 (41%). No intra-operative complication was encountered. Two children after staged Fowler-Stephens procedure and 1 child after inguinal orchidopexy had atrophic testes.
CONCLUSION: The use of laparoscopy in children with impalpable testes is a safe procedure and can guide the need for subsequent inguinal exploration. Children with unilateral impalpable testis were associated with an increased need for inguinal exploration after laparoscopy. Orchidopexies could be performed successfully in 90% of children with bilateral impalpable testes.
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Evans J, Cosgrove C, Huddart S, Lambert A. The unidirectional testicular tunneller: a simple, safe and novel device for orchidopexy in patients with palpable undescended testes. Pediatr Surg Int 2012; 28:693-6. [PMID: 22581126 DOI: 10.1007/s00383-012-3103-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Inguinal orchidopexy is already considered a safe procedure, this paper describes a simple new surgical instrument designed to make the operation easier, simpler and quicker, whilst reducing tissue trauma, in particular to the deep ring. The result of its use in two centres is presented. METHODS A unidirectional testicular tunneller has been developed comprising a head, shaft and eye. At operation, following testicular mobilisation, the tunneller is passed through the groin incision into the scrotum and a dartos pouch created by cutting against the head of the instrument. This allows more of a "no-touch" technique with less back and forth movement through the inguinal canal. The testis is attached to the eye of the instrument and pulled into the scrotum before fixation. RESULTS From November 2000 to December 2011, two surgeons operated on 592 boys using the instrument. 93 procedures were bilateral. All operations proceeded without incident and a healthy testis was safely and permanently placed in the scrotum. There were no complications related to the use of the tunneller. All were treated as day cases. CONCLUSION The instrument described in this paper simplifies inguinal orchidopexy, improves procedural safety and is felt to reduce surgical trauma. In view of these advantages and the absence of complications related to this instrument, its use in inguinal orchidopexy is recommended.
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Affiliation(s)
- Jonathan Evans
- Ministry of Defence Hospital Unit Derriford, Derriford Hospital, Plymouth, UK.
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