title: Laparoscopic manoeuvre for orchidopexy in high intra-abdominal testes when cremasteric artery is present.
abstract: OBJECTIVE
  We report a case of high intra-abdominal testes (HIT) associated with the presence of the cremasteric artery (CA). The aim was to correlate the normal anatomy of the CA with the clinical finding in our patient and discuss its surgical implication.
  
  
  METHODS
  Left primary laparoscopic testicular descent by the Prentiss manoeuvre was performed in a 2 year-old boy with bilateral HIT. Cadaveric dissection was carried out focusing on the anatomical origin of the CA. Data obtained from cadavers and the clinical findings were analyzed.
  
  
  RESULTS
  During laparoscopic orchiopexy a left HIT was found in the presence of the CA. Primary tension-free orchiopexy was achieved preserving the CA. Our cadaver study revealed that the CA arose more frequently (68%) from the medial aspect of the inferior epigastric artery.
  
  
  CONCLUSIONS
  In the presence of HIT, surgeons should be aware of the CA as part of the testicular collateral circulation. Acquaintance with the normal anatomy of the CA is important to determine the most appropriate laparoscopic manoeuvre in orchiopexy when this artery is present. We believe that the Prentiss manoeuvre avoids compression and strangulation of the CA around the epigastric vessels while allowing testicular placement in the scrotum.
authors.affiliation: Division of Pediatric Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ontario, Canada. cdecarli@cheo.on.ca
authors.forename: Claudio
authors.initials: C
authors.lastname: De Carli
authors.forename: Marcos
authors.initials: M
authors.lastname: Bettolli
authors.forename: Michael
authors.initials: M
authors.lastname: Leonard
authors.forename: Esteban
authors.initials: E
authors.lastname: Jauregui
authors.forename: Luis
authors.initials: L
authors.lastname: Guerra
mesh_terms: D001158:Arteries; D002675:Child, Preschool; D003456:Cryptorchidism / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D013737:Testis / Q000098:blood supply*; D013521:Urologic Surgical Procedures, Male / Q000379:methods