Laparoscopic Orchiopexy Versus Open Orchiopexy for Palpable Undescended Testis in Children: A Prospective Comparison Study

Abstract

Background: Can laparoscopic orchiopexy achieve a better testicular position and a higher success rate than open orchiopexy for palpable undescended testis in children? We conducted a prospective comparison study with a large volume of cases to answer this question. Methods: A total of 256 patients with palpable undescended testis who were admitted between January 1, 2017 and December 31, 2017 were included in this study. Among them, 124 patients underwent laparoscopic orchiopexy and 132 patients underwent open inguinal orchiopexy. The outcome evaluated index included final testicular position, success rate, and complications. Results: Of 256 patients, the mean age was 2.4 years; 218 patients had unilateral palpable testis, and the other 38 patients had bilateral palpable testis. There were no significant differences between laparoscopic orchiopexy group and open orchiopexy group with respect to age, side, preoperative testicular position, and testicular volume. The final testicular position in laparoscopic group was better than that in open group (lower position rate: 89.3% versus 77.9%, P = .01). There was no significant difference in success rate (laparoscopic group: 100%; and open group: 98.5%). There were 3 complications in the laparoscopic group and 6 complications in open group (P > .05). No testicular atrophy was found in either group. No testicular ascent occurred in laparoscopic group while there were 2 cases in open group, which required additional surgery for correction. Of patients who underwent surgery at the age of 3 years or older (n = 75), laparoscopic surgery was associated with markedly better testicular position than open surgery (lower position rate: 88.1% versus 69.6%, P = .03). Conclusions: Laparoscopic orchiopexy is associated with better testicular position and comparable success rate comparing to open orchiopexy for palpable undescended testis in children. This procedure could be recommended for palpable undescended testis, especially in older children.

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

“…They have highlighted all the benefits of minimally invasive surgery as the main advantage of LO together with the possibility of contralateral inguinal canal exploration in cases of patent processus vaginalis [11,[14][15][16][17][18][19][20][21]. The rates of complications, especially in regard to testicular atrophy and ascent after surgery were similar to the open approach in the majority of the published studies [14][15][16][17][18][19][20][21].…”

“…Subsequently, several authors have reported similar safety and efficacy with LO as compared to the conventional open orchiopexy (CO) for the management of inguinal undescended testicles [11,[14][15][16][17][18][19][20][21]. They have highlighted all the benefits of minimally invasive surgery as the main advantage of LO together with the possibility of contralateral inguinal canal exploration in cases of patent processus vaginalis [11,[14][15][16][17][18][19][20][21]. The rates of complications, especially in regard to testicular atrophy and ascent after surgery were similar to the open approach in the majority of the published studies [14][15][16][17][18][19][20][21].…”

“…About 25 years ago, the laparoscopic orchiopexy (LO) was first introduced by an American surgeon Steven Docimo for high-palpable undescended testes [13]. Subsequently, several authors have reported similar safety and efficacy with LO as compared to the conventional open orchiopexy (CO) for the management of inguinal undescended testicles [11,[14][15][16][17][18][19][20][21]. They have highlighted all the benefits of minimally invasive surgery as the main advantage of LO together with the possibility of contralateral inguinal canal exploration in cases of patent processus vaginalis [11,[14][15][16][17][18][19][20][21].…”

Clinical effect of minimally invasive surgery for inguinal cryptorchidism

“…Various minimally invasive procedures are performed to treat inguinal cryptorchidism to meet patients' aesthetic requirements. Laparoscopic orchiopexy has been the gold standard for the treatment of abdominal cryptorchidism and can also be performed for inguinal cryptorchidism to achieve an aesthetic effect [4][5][6][7][8][9][10] . Orchiopexy via a single scrotal incision can also be performed for inguinal cryptorchidism to improve the appearance [11][12][13][14] .…”

Clinical effect of minimally invasive surgery for inguinal cryptorchidism

“…Various minimally invasive procedures are performed to treat inguinal cryptorchidism to meet patients' aesthetic requirements. Laparoscopic orchiopexy has been the gold standard for the treatment of abdominal cryptorchidism and can also be performed for inguinal cryptorchidism to achieve an aesthetic effect [4][5][6][7][8][9][10] .…”