Utility of Laparoscopic Approach of Orchiopexy for Palpable Cryptorchidism: A Systematic Review and Meta-Analysis

Background: Traditional open orchiopexy is still a standard of treatment for palpable undescended testicles. Recently several authors reported successful results using a laparoscopic approach in the treatment of palpable cryptorchidism. The present systematic review and meta-analysis investigated the utility of laparoscopic orchiopexy for palpable cryptorchidism. Methods: Scientific databases (PubMed, Scopus, Web of Science, and EMBASE) were systematically searched for relevant articles using the following terms: (palpable cryptorchidism or palpable undescended testes) AND (laparoscopic orchiopexy or laparoscopic orchiopexy). The inclusion criteria were all children with unilateral or bilateral palpable undescended testes who underwent laparoscopic orchiopexy (LO) compared to children who underwent conventional open orchiopexy (CO). The main outcomes were the proportion of children requiring redo-orchiopexy and the incidence of postoperative complications. Secondary outcomes were duration and the cost of surgery. Results: The final meta-analysis included five studies involving 705 children; LO, n = 369 (52.3%) and CO, n = 336 (47.7%). The majority of the included patients had unilateral palpable cryptorchidism. No significant differences were found in regard to average age at the time of surgery and follow-up periods between the investigated groups. No statistically significant differences were found in regard to redo-orchiopexy rates (RR = 0.22, 95% CI 0.03–1.88, p = 0.17), early complications (RR = 0.66, 95% CI 0.21–2.08, p = 0.48) and incidence of testicular atrophy (RR = 0.36, 95% CI 0.03–3.88, p = 0.40). No significant differences in the operative duration were observed among the groups. Laparoscopy was associated with higher costs in most of the studies. Conclusion: LO is safe and effective in children with palpable cryptorchidism. The rates of redo-orchiopexy as well as an incidence of early complications and testicular atrophy rates are comparable to CO.

Laparoscopic Fowler-Stephens orchidopexy for intra-abdominal cryptorchid testis: a single institution experience

Fowler-Stephens Laparoscopic Orchiopexy (FSLO) permits the mobilization of Intra-Abdominal Testis (IAT) to the scrotal position after spermatic vessel ligation. We reported our experience of FSLO for IAT. The charts of all boys who underwent a FSLO were retrospectively reviewed. Data were analysed for demographic data, procedure, complications and follow-up results. From January 2008 to June 2016, 160 laparoscopies for Non Palpable Testis (NPT) were performed at a mean age of 3,2 years. 61% of patients had a right NPT, while 6% were bilateral. In 64 cases, an IAT was found: 20 were managed by FSLO with a two-stage procedure in 11 patients. There were no differences in hospitalisations; one patient had a prolonged ileus. Follow-up ranged from 1 to 8 years. Of the 20 patients who underwent FSLO, testicular atrophy developed in three; the remaining testes were in the scrotal position, with normal consistency. FSLO was applied in 31% of IAT. The overall success rate of the technique was 85 %. The percentage of atrophy associated after spermatic vessels interruption appears to provide a good chance of testicular survival.

Laparoscopic orchiopexy versus traditional inguinal incision orchidopexy for palpable undescended testes in cryptorchidism

Background ： Laparoscopic orchidopexy (LO) has become a standard procedure for the treatment of nonpalpable undescended testes. Nevertheless, the use of LO for palpable undescended testes still remains controversial. The aim of this study was to explore the impact of laparoscopic orchiopexy procedure on palpable undescended testes in children suffering from cryptorchidism. Methods: A retrospective study was performed for LO and traditional inguinal incision orchidopexy (TIO) carried out to treat palpable undescended testes. In total, 291 children aged 9 months to 96 months with either left or right side palpable inguinal canalicular testes were included. 170 patients received LO and 121 patients received TIO. Age, operative time and clinical outcomes of the patients were reviewed. Independent t test and Fisher’s exact test were performed by using the SPSS 25.0 software. Results: In the younger groups, the mean operative time (younger than 1 year old, 30.50±5.88 vs. 39.86±6.11 min; 1-2 years old, 34.43±6.65 vs. 40.23±8.74) and postoperative normal activity time (younger than 1 year old, 1.20±0.40 vs. 2.12±0.48 days; 1-2 years old, 1.58±0.50 vs. 2.02±0.43 days) of LO were significantly shorter than those in the TIO group ( P <0.05). The operative time of LO was significantly longer than that in the TIO group in older groups (aged>3 years old). 47 of 49 cases (95.9%) of patients aged less than 1 year old were treated by LO successfully. Among the patients aged 1-2 years, 80 of 86 cases (93.0%) successfully completed LO. Totally, 43 cases were transferred to inguinal incisions. Conclusion: LO is an appropriate choice for palpable undescended testes, especially in children younger than 2 years old. The percentage of successful LO decreased with the increasing age.