Bilateral Robot-Assisted Laparoscopic Orchiopexy for Undescended Testes
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Published on: May 27, 2022
Clark Higganbotham1, Gates Cook1, Adam Rensing1
1Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
Objective:
To describe our technique for surgically treating cryptorchidism with bilateral robot-assisted laparoscopic orchiopexy.
Background:
Nonpalpable, undescended testes are commonly seen by the pediatric urologist. It is recommended to surgically bring the testis into the scrotum early in life to decrease the higher risk of future testicular carcinomas seen in abdominal testes. Diagnostic laparoscopy with laparoscopic orchiopexy for viable, intraabdominal testes is the current standard of treatment.
Materials And Methods:
After confirming viable, intraabdominal testes with diagnostic laparoscopy, we used an umbilical camera port and docked the robot with two additional 8-mm ports one handsbreadth to the right and left of the umbilicus. We first mobilized the right testis due to its more proximal location. We incised the gubernaculum distally, and then dissected the vas deferens medially. We carried this mobilization to the left side and mobilized the left testis in a similar fashion. After incising the peritoneum and confirming adequate testicular laxity, we made two transscrotal incisions and pulled either testis into its respective hemiscrotum with a laparoscopic grasper and placed them into a subdartos pouch.
Results:
This technique demonstrated that robot-assisted laparoscopic orchiopexy is feasible when treating cryptorchidism. This is most applicable at institutions that already have robotic surgery capacity and are comfortable operating robotically. Limitations include that use of the robot usually increases the operative time and therefore length of anesthesia for the patient. There does not appear to be a significant difference in cost associated with robotic versus laparoscopic orchiopexy at our institution, though this may not be the case everywhere.
Conclusion:
Here we demonstrate successful use of bilateral robot-assisted laparoscopic orchiopexy to treat bilateral undescended testes in a pediatric male. Pediatric urologists can consider using this technique instead of traditional laparoscopic orchiopexy.
