LAPAROSCOPIC MANAGEMENT OF THE IMPALPABLE ABDOMINAL TESTIS

Laparoscopy is useful in both diagnosis and management of impalpable t estes. Intra-abdominal testicles can be removed laparoscopically if at rophic or can be partly devascularized by spermatic vessel clipping if apparently normal. Assessment of testicular revascularization would b e desirable prior to subsequent orchidopexy. A second-stage vasal-base d orchidopexy then can be performed once adequate testicular reperfusi on via the deferential pedicle is believed to have occurred. We have u sed both diagnostic and therapeutic laparoscopy in the management of 1 03 non-palpable testes over a period of six years. Open procedures fol lowing laparoscopy included 57 orchidopexies, 11 orchiectomies, and 1 microvascular testicular autotransplant. Thirteen laparoscopic interve ntions were performed: 5 orchiectomies for atrophic testes and 8 testi cular vessel clippings followed by 6 second-stage open inguinal orchid opexies. Color Doppler duplex ultrasonography was not found to be reli able for assessment of testicular revascularization following spermati c vessel clipping. There were 3 complications which were all related t o puncture with the Veress needle.