Two Stage Laparoscopic Assisted Fowler-Stephens Orchidopexy

Abstract

Laparoscopy is generally recommended for the diagnosis and management of all cases of nonpalpable undescended testes either unilateral or bilateral. The procedure is performed under general anesthesia and endotracheal intubation. An elective operation is usually performed in an ambulatory setting for healthy infants older than 6 months. The procedure starts with an explorative laparoscopy and identification of the testis, the configuration of the vas and vessels and their relation to the internal ring. In the first stage the spermatic vessels are exposed, dissected as high as possible, coagulated by bipolar or monopolar diathermy, and divided without any further dissection. The second stage for mobilization of the testis to the scrotum is done 4–6 weeks later. A vas pedicle flap is created using sharp and blunt dissection starting lateral to the internal ring and testis and then extending medially as far as 1 cm above and below the vas deferens. We always try to spare the gubernaculum which represents a source of collateral circulation to the testis after dividing the main testicular vessels. With the help of an atraumatic grasper inserted through a scrotal incision and emerging inside the abdomen between the inferior epigastric vessels and the medial umbilical ligament, the testis is grabbed and pulled down into the scrotum.