title: Laparoscopic Orchiopexy Requiring Vascular Division: A Randomized Study Comparing the Primary and Two-Stage Approaches.
abstract: BACKGROUND
  Intraabdominal testes that lack sufficient vessel length to perform an orchiopexy require division of the testicular vessels. Historically, the vessels are divided at the initial operation, and the orchiopexy is then performed as a two-stage procedure with the assumption for the development of neovascularization along the vas deferens during the interim. Recent reports suggest the orchiopexy may be performed primarily at the time of vessel division. However, these strategies have not been prospectively compared. Therefore, we conducted a randomized pilot trial to examine the role for a larger comparative study.
  
  
  METHODS
  After Internal Review Board approval, all patients undergoing laparoscopic orchiopexy for a nonpalpable testis were considered for enrollment. This study was designed as a pilot study to evaluate testicular survival at 6 months of follow-up. After consent was obtained, computer randomization was used to determine a primary or two-stage orchiopexy. All procedures were performed by five surgeons, and allotment had no affect on surgeon selection.
  
  
  RESULTS
  Between October 2007 and September 2013, 112 patients were enrolled in the study. Twenty-seven patients (14 primary and 13 two-stage) met criteria for randomization based on inability to bring the testis to the contralateral internal ring. There was no difference in the approach among surgeons. Mean operative time and cost significantly favored the primary approach, and testicular survival rates were the same.
  
  
  CONCLUSIONS
  Based on the data in our pilot study, approximately 70% of patients with a nonpalpable testis will not require vascular division. This study suggests that when vascular division is required, the primary orchiopexy may be equivalent to the traditional two-stage procedure with regard to testicular survival and superior to the two stage in total operative time and charges. These data provide evidence for sufficient equipoise to proceed with the development of a large multi-institutional trial comparing these two approaches.
authors.affiliation: 1 American Family Children's Hospital, Department of Surgery, University of Wisconsin , Madison, Wisconsin.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ostlie
authors.affiliation: 1 American Family Children's Hospital, Department of Surgery, University of Wisconsin , Madison, Wisconsin.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Leys
authors.affiliation: 2 The Center for Prospective Clinical Trials, Children's Mercy Hospital and Clinics , Kansas City, Missouri.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Fraser
authors.affiliation: 2 The Center for Prospective Clinical Trials, Children's Mercy Hospital and Clinics , Kansas City, Missouri.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Snyder
authors.affiliation: 2 The Center for Prospective Clinical Trials, Children's Mercy Hospital and Clinics , Kansas City, Missouri.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
mesh_terms: D003456:Cryptorchidism / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D061646:Operative Time; D056126:Orchiopexy / Q000379:methods*; D010865:Pilot Projects; D013737:Testis / Q000098:blood supply*; D016896:Treatment Outcome