Related Experiment Video
Updated: Aug 18, 2026
Vessel-Sparing Microsurgical Longitudinal Intussusception Vasoepididymostomy to Treat Epididymal Obstructive Azoospermia
Published on: May 27, 2022
Laparoscopy in the management of the impalpable undescended testis
G M Humphrey1, A S Najmaldin, D F Thomas
1St James's University Hospital and the General Infirmary Leeds, UK.
Insights
Laparoscopy is effective for managing intra-abdominal testes in children, often avoiding open surgery. While the first stage of the Fowler-Stephens procedure is feasible laparoscopically, subsequent stages require advanced skills.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Urology
Background:
- Undescended testes, particularly intra-abdominal ones, present management challenges.
- Laparoscopy offers a minimally invasive approach for diagnosis and treatment.
Purpose of the Study:
- To evaluate the efficacy and outcomes of laparoscopic management for intra-abdominal testes in children.
- To assess the feasibility of laparoscopic orchidopexy and the Fowler-Stephens procedure.
Main Methods:
- A prospective study of 48 children (aged 1-9 years) with unilateral impalpable undescended testes.
- Laparoscopic evaluation and surgical intervention, including single-stage orchidopexy and two-stage Fowler-Stephens procedures.
Main Results:
- Laparoscopy successfully diagnosed or treated intra-abdominal testes in 20 children.
- Ten children underwent successful laparoscopic single-stage orchidopexy with good scrotal positioning at 2-year follow-up.
- Ten children underwent a laparoscopic two-stage Fowler-Stephens procedure, with 80% palpable in the lower scrotum at 6-month follow-up.
Conclusions:
- Laparoscopy is a valuable tool for managing intra-abdominal testes, frequently avoiding the need for open groin exploration.
- The laparoscopic Fowler-Stephens procedure (first stage) is technically feasible, but achieving adequate testicular length for optimal positioning in single-stage or second-stage procedures requires significant laparoscopic expertise.
Background:
This study evaluates the role of laparoscopy for managing the intra-abdominal testis.
Methods:
Over 30 months, 48 children (six with previous groin explorations) underwent laparoscopy for a unilateral impalpable undescended testis. The patients' age ranged from 1 to 9 years.
Results:
Eleven children required insertion of 'working ports' for mobilization of obscuring colon before the diagnosis could be established. Twenty-eight children had an absent testis. In nine, vas and vessels entered the internal ring. In 19, vas and vessels ended blindly above the internal ring. Twenty children had an intra-abdominal testis. Ten underwent a laparoscopic single-stage orchidopexy (eight without and two with ligation of vessels); at a minimum follow-up of 2 years, one testis in this group had atrophied, three were located in the lower half of the scrotum and six in the upper half. The remaining ten children underwent a laparoscopic two-stage Fowler-Stephens operation. At a minimum follow-up of 6 months, eight of these testes were palpable in the lower half and two in the upper half of the scrotum. CONCLUSION In the majority of cases, laparoscopy obviates the need for groin exploration. Technically a first-stage Fowler-Stephens procedure can be performed easily and effectively via the laparoscope. However, the second-stage Fowler-Stephens procedure or single-stage orchidopexy requires laparoscopic skills and may not necessarily provide sufficient length to the testicular attachment.
