Laparoscopy for the impalpable testis

• Published in: British journal of surgery 1997-10, Vol.84 (10), p.1430-1432
• Main Authors: Godbole, P. P., Morecroft, J. A., Mackinnon, A. E.
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Cryptorchidism - diagnosis; Cryptorchidism - surgery; Endoscopy; Genital system; Humans; Infant; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Male; Medical sciences; Orchiectomy; Preoperative Care; Retrospective Studies; Testis - blood supply
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1111/j.1365-2168.1997.02817.x

Background Use of laparoscopy in the management of the impalpable testis remains controversial. Localization of the testis may help plan or obviate the need for groin exploration. This study reviews the need for inguinal exploration with respect to laparoscopic findings, particularly of vas and vessels entering a closed deep inguinal ring. Method Case notes of boys undergoing laparoscopy for undescended testes were reviewed retrospectively. Results Of 86 impalpable testes, 32 were intra‐abdominal and ten were absent with intra‐abdominal blind ending vas and vessels. In 17 instances the vas and vessels entered an open internal ring and in 26 a closed internal ring. In one boy neither vas, vessels nor testis were visualized. Of the 26 impalpable testes with a closed internal ring, excision of testicular remnants in 18 revealed no histological testicular parenchyma, one boy had bilateral perineal ectopic testes missed clinically and six were not explored. Conclusion The laparoscopic finding of vas and vessels entering a closed deep inguinal ring should prompt a careful examination for an ectopic testis. If a palpable testis can be ruled out, inguinal exploration is not necessary, as viable testicular parenchyma is rarely found. Laparoscopy would have avoided negative exploration in 42 per cent of impalpable testes in this series.