A boy with undescended Testis (Cryptorchidism)

A 1.5 years old boy was brought with absent testis in both sides of scrotum.
A clinical examination revealed left testis to be retractile (which goes up but can be brought down- a normal phenomenon in young age group) and right testis to be an undescended testis. This testis could not be felt on clinical examination.

Parents were explained and the child was taken up for Laparoscopy for diagnosis and treatment

Laparoscopy showed the testis to be present inside the abdomen. This was mobilized and brought down to normal position in the scrotum with laparoscopy.

Showing right scrotum empty Laparoscopic orchipexy finished- the telescope inserted via belly button Laparoscopic view showing right testis inside the belly
Laparoscopy in cases with undescended testis

Laparoscopy or Key Hole Surgery is a recent advance in medicine and has become immensely popular in last two decades. Pediatric Laparoscopy or laparoscopic surgery in children is an upcoming specialty and it has been possible due to availability of miniaturized equipment, small telescopes and above all well trained doctors. The concept of laparoscopy in children is very appealing and is being applied to more and more surgical problems in kids.

For laparoscopy, initially a small hole is made in the belly button or navel to put a telescope and also to infuse a harmless gas (generally carbon dioxide) into the belly. This inflates the belly and gives working space to the surgeon. Then through small holes, instruments are put to perform the procedure. These instruments for kids are really small—the tip size is just 3 mm. A camera is attached to the telescope and is used to watch the procedure on a monitor in a magnified and more precise way. At the end of the surgery, the instruments are removed from the belly and one or two stitches are put within the skin to finish the procedure. These stitches need not be removed. It is amazing how extensive procedures can be performed with 3-4 key hole punctures.
 
Role of laparoscopy in undescended testis
  • Laparoscopy is especially indicated if the testis cannot be felt on clinical examination by a skilled physician signifying that testis is either present inside the belly or may be absent. Rarely a small testis in inguinal canal may not be felt clinically.
  • It has been seen in various studies that Ultrasound, CT scan and MRI scan may not be 100% reliable in diagnosing an absent testis or testis within the belly.
  • Laparoscopy is the gold standard for establishing whether a non-palpable testis is present or absent and also assessing the location to study the feasibility of bringing it down in one stage.
  • If the testis is present inside belly a simultaneous Laparoscopic Orchiopexy can be done to bring the testis to normal position.
  • Rarely a testis may be located very high up in the belly- in such cases a two staged approach may be required to bring down the testis with a success rate of 90%.
 
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