Please wait loading VIdeo Lecture of Prof. R.K. Mishra about Safe Laparoscopic Orcheopexy...
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Impalpable and undescended testes are a common preoccupation for specialized pediatric surgery teams. Laparoscopy as one of the most accurate modalities for diagnosis and localization of impalpable undescended gonad is more successful.
However the therapeutic attitude and the technique are still a matter of debate. No special investigative workup with ultrasound, CT or MRI scan was done in this study. It was because of the known inadequate sensitivity and specificity of ultrasound like a diagnostic modality for abdominal testis.
A CT scan exposes the child to radiation while the cost of a contrast MRI doesn't justify its use when laparoscopy is available both as a diagnostic and therapeutic modality. Within this preliminary study, we have deliberately not closed the interior ring round the pulled through spermatic cord. This method was prompted through the observation that the majority of the testes lie around the internal ring.
The mobilization of these testes by division from the gubernaculum and the dissection necessary to free a long loop vas deferens leads to a large raw area in the internal ring. Once the testis is pulled down into the scrotum, the mobilized top of the spermatic cord is within apposition with the raw area in the internal ring. Healing from the peritoneum occurs rapidly and so leads to a reasonable closure of the internal ring. This is supported by the truth that many surgeons feel that ligation from the hernial sac in herniotomy is not required
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