Laparoscopic orchiopexy without division of the spermatic vessels - Can itbe considered the procedure of choice in cases of intraabdominal testis?

Background: Several surgical procedures have been described for the managem ent of nonpalpable testis, Following a vast experience with a complete lapa roscopic two-stage Fowler-Stephens procedure, we report our experience with laparoscopic orchiopexy performed without dividing the spermatic vessels, Methods: Over a 24-month period, 70 boys with nonpalpable testes (72 overal l) underwent laparoscopic diagnostic exploration, Twenty patients (27.8%) o f this series who showed an intraabdominal testis underwent laparoscopic or chiopexy without sectioning the spermatic vessels. In seven cases, the test is was just proximal to the internal inguinal ring; in 13, it was in the hi gh intraabdominal position. The technique consisted in sectioning the guber naculum (when present), opening the peritoneum laterally to the spermatic v essels, and mobilizing the testicular vessels and the vas deferens in a ret roperitoneal position for 8-10 cm. The testis was then brought down into th e scrotum through the internal inguinal ring (11 cases), if this was open, or through a neo-inguinal ring (nine cases) created medially to the epigast ric vessels. In every case, we closed the inguinal ring at the end of the o peration using one or two detached sutures, Results: Operating time ranged between 40 and 75 min (median, 55). All the testes were successfully brought down into the scrotum. We had only one (5% ) intraoperative complication. In the second patient treated with this proc edure, there was an iatrogenic rupture of the spermatic vessels due to exce ssive traction. Conclusion: On the basis of our experience, we believe that laparoscopic or chiopexy without division of the spermatic vessels should be the treatment of choice in the management of nonpalpable testes, because it does not affe ct normal testicular vascularization and is minimally invasive. A blunt dis section and a delicate manipulation of the testis without excessive tractio n are the best ways to avoid any kind of complication.