Orchidopexy Laparoscopic Stage 1

Stage 1 laparoscopic orchidopexy is the high intra-abdominal undescended testis (UDT) managed by a staged technique when the testis cannot be brought down to the scrotum in 1 stage without tension. The aim of stage 1 is to make the testes ready for future descent by maintaining its blood supply through collaterals.

Indication

• Intra-abdominal testis high above the internal ring.
• Short testicular vessels which do not allow the safe single-stage orchidopexy.
• Good-sized testis with no atrophy.

Purpose

To laparoscopically divide the testicular vessels (Fowler-Stephens procedure) to permit the development of collateral blood flow from the vasal and cremasteric arteries prior to mobilizing the testis at stage 2 (6-9 months)

Laparoscopic stage 1 orchidopexy procedure

Stage 1 laparoscopic orchidopexy is indicated when the UDT is situated too far up in the abdomen for the vessels to be lengthened sufficiently to reach the scrotum in 1 operation.

The objective of the first stage is to interrupt the primary testicular vessels, so that an alternative circulation can be developed through the vasal and cremasteric arteries, permitting a secured descent of the testis in the stage 2 (6-9 months).

Preoperative Preparation

• General anaesthesia is given. In the supine position with a slight tilt (head down), so that the bowel moves away from the pelvis.
• Antibiotic prophylaxis is administered.
• The abdomen and groin is prepped and draped.

Surgical Technique: Step by Step

Placement of Ports

The 3-port technique is commonly used:

• Umbilical port (5 mm) for the camera.
• Two working ports (3–5 mm) are introduced in the lower quadrants along parallels to the umbilicus.
• A pneumoperitoneum is established (by CO₂ insufflation at a pressure of 8–12 mmHg).

Identification of Structures

• The intra-abdominal testis, testicular vessels and vas are identified and inspected.
• The testis position (high or low) and volume are recorded.

Mobilization

• The peritoneum is incised along the pathway of the testicular vessels and vas deferens.
• The vessels and the vas are then meticulously dissected and mobilized with the goal to liberate the testis from the surrounding structures.
• The testis is evaluated for a tension-free descent — if not feasible, a two-stage procedure is validated.

Division of Testicular Vessels

• The testicular artery and vein are titanium or polymer clips ligated and divided close to the internal ring or the retroperitoneum.
• The artery to the vas deferens and the vas deferens are preserved.
• This step enhances the formation of collateral circulation from the vasal and cremasteric vessels to sustain testicular viability.

Testicular Placement

• The testis may be left in situ in its present abdominal position, or anchored near the internal ring (optional) for prevention of torsion. 

Hemostasis and Closure

• Hemostasis was confirmed.
• CO₂ gas is withdrawn and the ports are taken out.
• The skin incisions were closed with absorbable sutures.

After Surgery Care

• The child is usually sent home the same day or within 24 hours.
• Pain relief with mild analgesics.
• Follow up: 1–2 weeks to review the wound.

1-stage Fowler-Stephens orchidopexy laparoscopic

The one-stage Fowler-Stephens orchidopexy is done for a high intra-abdominal testis when the spermatic vessels are short, but it is possible to place the testis in the scrotum at the same time of dividing the testicular vessels.

It depends on the collateral blood supply from the vasal and cremasteric artery to keep viability of the testis.

Indications

• Intra-abdominal testis within 2–3 cm from the internal inguinal ring.
• A potentially good size testis with a well-developed vas deferens.
• Sufficient collateral blood supply for a divided vessel.
• Single-stage correction preferred (no second operation planned).

Principle

• The testicular artery and vein are ligated in the same procedure.
• The testis is brought down and pinned in the scrotum (orchidopexy) in a single-stage.
• Testicular blood flow is sustained by collateral circulation through the vasal and cremasteric vessels.

Laparoscopic orchidopexy stage 1 recovery

The purpose of the first-stage repair is to permit the formation of the collaterals to the testis (from the vasal and cremasteric arteries) after the division of the primary testicular vessels.

This keeps the testes viable, waiting for Stage 2 (bringing it into the scrotum), that is done after a few months.

Immediate Postoperative Period (Day 0–1)

• Hospital stay: Most patients go home within 24 hours. 
• Pain: Mild to moderate cramping in the abdomen.
• Diet: The patient may take light diet once fully awake from anaesthetics.
• Activity: Rest the first 24 hours, and then you may gradually resume light activities.

Incision care:

• Small laparoscopic port sites (3–5 mm) are dressed with sterile gauze.
• Keep clean and dry for 48 hours.

Postoperative Week 1

• Pain: There is mild pain or discomfort for 2–3 days.
• Activity: Can walk normally in 1–2 days.
• Bathing: Baths are typically permitted 48–72 hours post-op if the wounds are dry.
• School/Work: May return in 3–5 days, no heavy lifting.
• Medications: Continue with oral pain medications or antibiotics (if prescribed).
• Diet: Regular diet as tolerated.

Weeks 2–4

• Wound healing: Port sites heal completely. Stiches (if non absorbable) can be removed after 7-10 days.
• Pain: Typically resolved.
• Activity gradual return to all activities: Do not participate in any vigorous activities or exercise or bike for 2-3 weeks.
• Follow-up: Post-operative appointment at 1-2 weeks for healing check and assurance of no complications.

Long-Term Recovery (Up to 9 Months)

• The testis remains in its intra-abdominal or near-ring position during this period.
• Over the next 6–9 months, collateral blood supply will be established through the vasal and cremasteric arteries.
• No scrotal visible change yet — the testis will be brought down into the scrotum in Stage 2 surgery.
• Follow-up visits every 3–4 months may also include ultrasound to monitor testicular size and blood flow. 

Single stage laparoscopic orchidopexy

One-stage laparoscopic orchidopexy is a minimally invasive technique to identify, free and fix an undescended testicle (UDT) into the scrotal sac in a single operation.

It is done for a testis that is low intra-abdominal or at the internal inguinal ring and can be delivered into the scrotum without dividing the testicular vessels, or after dividing them, safely, in one sitting.

Best hospital for laparoscopic stage 1 orchidopexy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Single stage laparoscopic orchidopexy is an accepted, safe, effective and minimally invasive procedure for low intra-abdominal or high inguinal undescended testes. The surgeon can see, free, and fix the testis into the scrotum in a single stage procedure, with the least possible discomfort and fastest recovery. It provides outstanding cosmetic results, a high rate of success and the potential to preserve future fertility if performed early by an experienced surgeon. To gain maximum testicular viability, staged Fowler-Stephens (F-S) may still be the preferred approach for higher abdominal testes with short vessels.

Affordable laparoscopic stage 1 orchidopexy India GetWellGo

GetWellGo is regarded as a leading supplier of healthcare services. We help our foreign clients choose the best treatment locations that suit their needs both financially and medically.

We offer:

• Complete transparency
• Fair costs.
• 24 hour availability.
• Medical E-visas
• Online consultation from recognized Indian experts.
• Assistance in selecting India's top hospitals for laparoscopic stage 1 orchidopexy treatment.
• Expert urosurgeon with a strong track record of success
• Assistance during and after the course of treatment.
• Language Support
• Travel and Accommodation Services
• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
• Currency Exchange
• Arranging Patient’s local food

FAQ

1. What about other visible signs?

• 3–5 mm small keyhole scars are left, they fade over time and they are hardly visible.

2. Will my child need another operation in the future?

• No second operation if the testis is healthy and well situated.
• Follow up care is via PE or US to confirm normal growth.

3. Can we operate both testicles at the same time?

• Yes. Both the undescended testes can be brought down in the same sitting in case they lie undescended.