Laparoscopy Assisted versus Standard Inguinal Orchiopexy for High Palpable Undescended Testes

Background/Purpose: In high palpable undescended testes, many surgeons perform inguinal orchiopexy routinely. Some surgeons prefer a totally laparoscopic approach. Technically, this is not always possible. However, laparoscopy could still be valuable in dissecting the testicular pedicle before proceeding to the standard inguinal orchiopexy. The purpose of this study was to evaluate the advantages of such strategy. Patients and Methods: The study included thirty-eight children, with 48 high palpable undescended testes treated by the author over 2 1/2 years. These were divided into two groups. Group [I] comprised 34 high palpable undescended testes, treated by the standard-inguinal orchiopexy without laparoscopy. Group [II] comprised 14 high palpable undescended testes treated by laparoscopy assisted orchiopexy. Both groups were compared with regard to the need to divide the spermatic-vessels, level of fixation of the testis (at the bottom of the scrotum or at a higher level), the need for second stage operation and testicular volume during follow-up. Results: In group [I], 3 cases (8.8%) required sectioning of the spermatic vessels; 8 cases (23.5%) required a second stage, 5 cases (14.7%) had high testicular fixation, and 5 cases (14.7%) showed testicular volume reduction during follow-up. In group [II], only 1 case (7%) required spermatic cord sectioning. Conclusion: In high palpable undescended testes, laparoscopic dissection of the testicular pedicle before standard inguinal orchiopexy is helpful. It gives the length required for bringing the testis into proper scrotal-position, avoids compromising vascularity of the testis or expose cord structures to injury and might completely eliminate the need for a second stage intervention with its potential complications.