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DOI: 10.1055/s-0030-1262950
Combined Laparoscopic and Microsurgical Techniques for Testicular Autotransplantation: Is this Still an Evolving Technique?
Publication History
Publication Date:
16 July 2010 (online)
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ABSTRACT
Testicular autotransplantation is an advanced technique for the correction of high intra-abdominal testicles with inadequate vascular length for repositioning in the scrotum. In the past, surgeons have often avoided this approach due to the extended operative time and the requirement for microsurgical equipment and training. Surprisingly, this procedure remains rare despite the fact that autotransplantation is sometimes the most viable option to relocate the testicle. Further, current advances in laparoscopic surgery allow for testicular harvesting with minimal morbidity and maximal vascular pedicle length. Here, the evolution and an approach combining these two techniques implemented successfully in five patients are presented.
KEYWORDS
Laparoscopic - testicular - autotransplantation - microsurgery
REFERENCES
- 1 Esposito C, Caldamone A A, Settimi A, El-Ghoneimi A. Medscape . Management of boys with nonpalpable undescended testis. Nat Clin Pract Urol. 2008; 5 252-260
- 2 Krabbe S, Skakkebaek N E, Berthelsen J G et al.. High incidence of undetected neoplasia in maldescended testes. Lancet. 1979; 1 999-1000
- 3 Rosito N C, Koff W J, da Silva Oliveira T L, Cerski C T, Salle J L. Volumetric and histological findings in intra-abdominal testes before and after division of spermatic vessels. J Urol. 2004; 171(6 Pt 1) 2430-2433
- 4 Scorer C G. The descent of the testis. Arch Dis Child. 1964; 39 605-609
- 5 Zerella J T, McGill L C. Survival of nonpalpable undescended testicles after orchiopexy. J Pediatr Surg. 1993; 28 251-253
- 6 Fowler R, Stephens F D. The role of testicular vascular anatomy in the salvage of high undescended testes. Aust N Z J Surg. 1959; 29 92-106
- 7 Law G S, Pérez L M, Joseph D B. Two-stage Fowler-Stephens orchiopexy with laparoscopic clipping of the spermatic vessels. J Urol. 1997; 158(3 Pt 2) 1205-1207
- 8 Silber S J, Kelly J. Successful autotransplantation of an intra-abdominal testis to the scrotum by microvascular technique. J Urol. 1976; 115 452-454
- 9 Tackett L D, Wacksman J, Billmire D, Sheldon C A, Minevich E. The high intra-abdominal testis: technique and long-term success of laparoscopic testicular autotransplantation. J Endourol. 2002; 16 359-361
- 10 Bukowski T P, Wacksman J, Billmire D A, Lewis A G, Sheldon C A. Testicular autotransplantation: a 17-year review of an effective approach to the management of the intra-abdominal testis. J Urol. 1995; 154(2 Pt 1) 558-561
- 11 Docimo S G. The results of surgical therapy for cryptorchidism: a literature review and analysis. J Urol. 1995; 154 1148-1152
- 12 Snyder III H M. Bilateral undescended testes. Eur J Pediatr. 1993; 152(Suppl 2) S45-S46
- 13 Canavese F, Cortese M G, Gennari F et al.. Non-palpable testes. Orchiopexy in single stage. Eur J Pediatr Surg. 1995; 5 104-105
- 14 Esposito C, Vallone G, Settimi A, Gonzalez Sabin M A, Amici G, Cusano T. Laparoscopic orchiopexy without division of the spermatic vessels: can it be considered the procedure of choice in cases of intraabdominal testis?. Surg Endosc. 2000; 14 658-660
- 15 O'Brien M F, Hegarty P K, Healy C, DeFrietas D, Bredin H C. One-stage Fowler-Stephens orchidopexy for impalpable undescended testis. Ir J Med Sci. 2004; 173 18-19
- 16 Daher P, Nabbout P, Feghali J, Riachy E. Is the Fowler-Stephens procedure still indicated for the treatment of nonpalpable intraabdominal testis?. J Pediatr Surg. 2009; 44 1999-2003
- 17 Earle S A, Marshall D M, Labbie A S. First clinical use of an omental pedicle flap for the surgical correction of a high intra-abdominal testicle. Plast Reconstr Surg. 2008; 121 231e-232e
- 18 Peters C A. Laparoscopy in pediatric urology. Curr Opin Urol. 2004; 14 67-73
Lior HellerM.D.
Department of Plastic Surgery, Baylor College of Medicine, One Baylor Plaza, Houston
TX 77030
Email: lheller@bcm.edu