Single setting bilateral laparoscopic orchiopexy for bilateral intra-abdominal testicles.

Purpose: The laparoscopic surgical approach to unilateral intra-abdominal testis has replaced the open approach at several large centers. There is considerable literature on experience with unilateral intra-abdominal testes but little on the management of bilateral intra-abdominal testes. We assessed the feasibility and safety of performing single setting bilateral laparoscopic orchiopexy in boys with bilateral intra-abdominal testes.

Materials And Methods: A single surgeon experience was reviewed. The surgical technique was similar in all cases and on each side, including infra-umbilical access, diagnostic evaluation, peritoneal mobilization lateral to the spermatic vessels and inferior to the vas deferens, gubernacular transection, and a decision for or against a Fowler-Stephens procedure and testis relocation into the scrotum with fixation. Followup consisted of physical examination 14 days, 6 months and 1 year postoperatively, when testicular position and size were assessed. Intraoperative and postoperative complications were noted.

Results: Single setting bilateral laparoscopic orchiopexy was attempted in a total of 42 testes in 21 boys with a median age of 9 months (range 7 to 52). It was completed in a total of 36 testes in 18 boys. All procedures were performed on an outpatient basis. Of the 42 testes orchiopexy was performed in 4 with Fowler-Stephens ligation, including at a 1 and 2-stage procedure in 2 each. Although the latter 2 cases account for 2 of the 3 not completed at a single setting, excellent outcomes were achieved in these cases at the second setting, yielding bilateral intrascrotal testes in each. A third boy required a subsequent open procedure for relocation of a testis from an inferior pubic/superior scrotal position to a more dependent portion of the scrotum. Testicular position after laparoscopy was the mid lower scrotum in 38 cases, upper scrotum in 3 and inferior pubic/superior scrotal in 1. Atrophy was noted in 2 of the 42 testes (19 of 21 boys) at 6-month followup, including in 1 boy who underwent a 1-stage Fowler-Stephens procedure and 1 who underwent nonFowler-Stephens orchiopexy. Of the 21 boys 16 required only 1 surgery to achieve viable intrascrotal testes at 1-year followup. Of the 21 boys 19 (91%) ultimately achieved bilateral viable intrascrotal testes. There was no correlation between patient age and the likelihood of success or failure. No patient experienced any complications or hospital admissions.

Conclusions: In boys with bilateral intra-abdominal testes single setting bilateral laparoscopic orchiopexy can be performed safely on an outpatient basis with a high degree of success. Most boys undergo a single surgery with the testes relocated to a satisfactory intrascrotal position without atrophy.