title: Laparoscopy-assisted orchidopexy: an ideal treatment for children with intra-abdominal testes.
abstract: OBJECTIVE
  The investigation of a child with a nonpalpable testis is probably the most frequent indication for laparoscopy in pediatric patients. The objective of this study was to evaluate the results and advantages of laparoscopy-assisted orchidopexy performed without dividing the spermatic vessels.
  
  
  METHODS
  During a 3-year period, 85 boys with nonpalpable testes (NPT) (91 testes overall) underwent laparoscopic diagnostic exploration. Twenty-five patients (27.4%) showed an intra-abdominal testis (IAT): 24 underwent a laparoscopy-assisted orchidopexy (LAO) without sectioning of the spermatic vessels, and one, whose inner spermatic vessels were not adequately long for LAO without tension, underwent a two-step Fowler-Stephens (FS) procedure. The technique consists of dissection and mobilization of the inner spermatic vessels and the vas deferens from the posterior peritoneum, sectioning of the gubernaculum attachments, and bringing down of the testis into the scrotum through the internal inguinal ring, if open, or through a neo-inguinal ring created medial to the epigastric vessels.
  
  
  RESULTS
  Surgery lasted between 40 and 80 minutes (median 60 minutes). All the testes were brought down into the scrotum. There was only 1 (4%) intraoperative complication, which occurred in the second patient operated on with this procedure. He experienced an iatrogenic rupture of the spermatic vessels secondary to excessive traction.
  
  
  CONCLUSIONS
  Laparoscopic orchidopexy is the logical extension of diagnostic laparoscopy for the evaluation of NPT. Concerning the technique, we believe that LAO with intact spermatic vessels could be considered the treatment of choice in the patient with IAT, as it does not affect normal testicular vascularization. Alternatively, in the case of very high IAT (more than 3 cm from IIR), an FS procedure may be considered.
authors.affiliation: Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy. ciroesp2@unicz.it
authors.forename: Ciro
authors.initials: C
authors.lastname: Esposito
authors.forename: Rocco
authors.initials: R
authors.lastname: Damiano
authors.forename: Miguel Antonio
authors.initials: MA
authors.lastname: Gonzalez Sabin
authors.forename: Antonio
authors.initials: A
authors.lastname: Savanelli
authors.forename: Antonella
authors.initials: A
authors.lastname: Centonze
authors.forename: Alessandro
authors.initials: A
authors.lastname: Settimi
authors.forename: Rosario
authors.initials: R
authors.lastname: Sacco
mesh_terms: D002648:Child; D002675:Child, Preschool; D003456:Cryptorchidism / Q000175:diagnosis* / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D013519:Urogenital Surgical Procedures / Q000379:methods