The nonpalpable testis and the changing role of laparoscopy

To show the reliability of laparoscopic procedures in case of cryptorchidism. It also shows the growing possibilities of laparoscopic manipulations of the cryptorchid testis obviating in a great percentage the need for open operative procedures.

Starting from the standard diagnostic laparoscopic procedure we gradually extended its use to a full operative procedure. The standard procedure is extensively elucidated in the way we used it in sixty-one laparoscopic procedures for seventy-four non-palpable testes.

All laparoscopies were technically successful. Forty testes (60.3%) were found intra-abdominally. Four testes (5.5%) were found lying in the inguinal canal or in an ectopic position. Twenty-five testes were absent. The diagnosis of a vanishing testis could be established in most of these cases. In the beginning period the following open procedures were done after the diagnostic laparoscopy: sixteen open explorations, ten formal standard orchidopexies; nine orchiectomies, nine autotransplantations, and three Fowler-Stephens procedures. In recent years we proceeded with laparoscopic manipulation, performing eleven laparoscopically assisted orchidopexy procedures (LAOPs), six extended laparoscopic explorations, and two laparoscopic orchiectomies.

Laparoscopy is not only a safe and reliable method in diagnosing the presence of a nonpalpable testis, but also thanks to more sophisticated instruments allows us more and more to perform the complete treatment. It can facilitate the placement of surgical incisions or obviate the need for further open intervention if no spermatic vessels are visualized in the abdomen.