THE USE OF LAPAROSCOPY IN THE MANAGEMENT OF THE NONPALPABLE TESTIS

Fifty-eight children with a nonpalpable testis have been evaluated at our institution between 1988 and 1994. Laparoscopy was performed in th ese children to effect a treatment plan. The children range in age fro m 10 months to 14 years. Thirty patients had a nonpalpable left testis , 18 had a nonpalpable right testis, and 10 had bilateral nonpalpable testes. In 28 children, a testis was visualized. Two underwent laparos copic orchiectomy and 26 underwent either a standard single stage proc edure (11), a staged open procedure (3), or a laparoscopically assiste d staged procedure (12). Attenuated vessels were seen in 26 patients a nd inguinal exploration revealed a viable testis in 6 patients and a t estis remnant, which was removed, in 20 patients. Four patients had la paroscopic blind-ending vessels. Diagnostic laparoscopy affords the su rgeon not only the ability to localize the testis with virtual certain ty, but also the advantage of planning a highly successful treatment p rogram. The position of the testis intraabdominally and the length of the spermatic vessels can be easily evaluated to decide whether a stag ed approach versus a single stage procedure can be performed. The use of the KTP laser has made the two staged procedure quite easy with onl y one Trocar site necessary. This experience has allowed us to develop and modify an algorithm for the effective management of the nonpalpab le testis.