Muataz A. Al Ani , Bassam Kh. Al Abassy
Pediatric Surgeons
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Cryptorchidism is a common finding in pediatric
practice ,
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 21% of preterm male infant.
 1.8-4 % of full term boys.
 0.8% of 1 year old boys.
The proportion of impalpable testis has been
reported up to 20% of all cryptorchied boys.
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A variety of imaging modalities have been used to
detect the impalpable testis,
Ultrasound, Computed tomography, Magnetic
resonance imaging, Arterography and venography.
Non are as sensitive as laparoscopy for accurate
localization of the intra abdominal testes.
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Cortesi et al first reported the use of laparoscopy in
the surgical management of impalpable testes in
1976.
Initially, laparoscopy was used only for localization
before open surgical exploration. It is only recently
that laparoscopy been deemed a means of both
diagnosis and treatment.
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Aim Of The Study
The purposes of our study was:
 To evaluate the role of laparoscopy in localizing
impalpable testes.
 The management strategy for both unilateral
and bilateral impalpable testes .
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Patients And Methods
Throughout the period between January 2005 to
December 2008 ,
A 36 patients with impalpable testes were
admitted to the pediatric surgery centre at Al
khansa teaching hospital in Mosul /Iraq ,
Laparoscopy done for them to assess and
manage 42 impalpable testes.
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Ports
5-10 mm supra-umbilica port for 0ºtelescope
For diagnostic laparoscopy:
at least an additional port is needed.
For therapeutic management:
additional 2 working ports in the flanks.
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Result And Discussion
Intra abdominal testes are classified according to the
laparoscopic findings
Intra Canalicular Testes
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Intra Abdominal Testis Are
Classified According To The
Laparoscopic Findings
Intra Abdominal Testis
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Intra Abdominal Testis Are
Classified According To The
Laparoscopic Findings
vanished testes
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Teratoma
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Persistent Miillerian Duct Structures
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A viable intra-abdominal
testis
The limiting factor to relocate the intraabdominal testis to the scrotum is
the length of the gonadal vessels.
Assisted laparoscopic orchiopexy.
Single stage Fowler-Stephen technique.
Two stage Fowler-Stephen technique.
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Result And Discussion
36 PATIENTS
(42 IMPALPABLE TESTES)
15 Testes Absents
Vanished Testes
12 Vas And Vessel
Enter The Internal
Ring
27 Testes
Were
Positive
3 With No Vas And
Vessel Entering The
Ring (Agenesis).
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27 Testes
Positive
16 Near The
Internal
Inguinal Ring
2 Testes
Intra
Canaliculare
9 In The
Iliac Fosse
Assisted
laparoscopic
orchiopexy
Single stage
Fowler-Stephen
technique in 4
testes
Two stages
Fowler-Stephen
technique in 2
testes
Biopsy In 3
testes
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We followed our patients for about two years by assessing
the size of the fixed testis in comparism to the other one
and in relation to patient age.
Condition Of The
Testis
Good size
Small size
Atrophy
Total
Assisted
Laparoscopic
Orchiopexy
13
4
1
18
F. S Procedure
%
5
1 one stage
0
6
75
21.8
4.2
100
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Conclusion
laparoscopy has a safe, reliable and accurate role in
management of impalpable testis .
It also direct the surgeon to chose the proper technique
for orchiopexy .
One stage assisted laparoscopic orchiopexy.
Single stage Fowler Stephen laparoscopic orchiopexy .
Two stages Fowler Stephen laparoscopic orchiopexy.
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