Orchidopexy Bilateral Laparoscopic

Bilateral laparoscopic orchidopexy

Bilateral Laparoscopic Orchidopexy is a minimally invasive technique to treat bilateral undescended testicle in which both testicles failed to drop in scrotum. The application of laparoscopy provides a much clearer view of the surgical site, and also is has been known to provide for smaller incisions and a quicker recovery for the patient when compared to that of an open procedure.

Indications

The indications for laparoscopic orchidopexy include:

• Both testes are non-palpable (do not feel in the scrotal sac).
• The undescended testis is intra-abdominal.
• There is one to capture by snare and treat simultaneously.
• Prior to open orchidopexy attempts have failed disastrously.

Laparoscopic orchidopexy bilateral surgery

Surgery including Purpose:

• Bilateral undescended testicles (UDT) need to be corrected early because: 2 out of every 100 boys are born with bilateral UDT
• Because these conditions affect the potential for fertility.
• Failure to treat is associated with an increased risk of testicular cancer.
• It could cause psychological distress or cosmetic concerns in older children.
• Hernia and torsion (twisting of the testis) may also be related to this abnormal position.

Bilateral laparoscopic orchidopexy procedure

Bilateral laparoscopic orchidopexy is a surgery performed using small instruments inserted into small incisions to move two undescended testicles into the scrotum. It is generally advised in the case of children when testis is non-palpable on both sides and/or found in the abdomen. With better visualization and smaller scars, the laparoscopic approach allows for a quicker healing process than the open approach.

Step-by-Step Procedure:

Anaesthesia and Positioning

• To ensure that the patient remains comfortable, the patient is induced to sleep with general anaesthesia.
• The child (or patient) is placed supine (on their back) with legs parted slightly to see both the scrotum and abdomen.

Creating Laparoscopic Access

• A tiny incision about 5mm wide is made at the navel to insert a laparoscopic camera (telescope).
• Carbon dioxide gas (CO₂) is used to inflate the abdomen (pneumoperitoneum) to improve visualization.
• Two more tiny cuts of 3 to 5 mm each are made on either side of the stomach for the surgical tools.

Identification of Testes

• The surgeon examines the abdomen to find the two testicles.
• The vas and testicular vessels are followed from the internal ring for the position and status of the testes. 

Testes mobilization

• The spermatic cord, testicular vessels, and vas deferens are gently dissected free from surrounding tissue for appropriate length.
• This allows the testicles to be brought down to the scrotum without tension.

Establishing of the scrotal pouches

• Two tiny slits are created in the scrotum (one on each side).
• Blunt dissection is used to form pouches for each testicle.

Descent of the Testes

• The testes are delivered through the internal ring and into the pouches of the scrotum.
• Care is taken so as not to twist the spermatic cord.

Fixation (Orchidopexy)

• The testis is affixed in the scrotum with absorbable stitches to avoid retraction.
• The attitudes for both are checked to make sure that the two testes rest properly and symmetrically within the scrotum.

Closure

• The CO₂ is allowed to escape from the abdomen.
• Laparoscopic instruments are taken out.
• The tiny incisions in your abdomen and scrotum are closed with either dissolvable stitches or glue for your skin.
• A sterile gauze dressing is applied.

Duration of surgery

• The procedure usually lasts from 60 to 90 minutes, depending upon the location of the testes and the complexity of the surgery.

Two-Stage Fowler-Stephens Procedure (If Required)

If the testes are high intra-abdominal and cannot be mobilized safely in one stage:

• Stage 1: The testicular vessels are ligated in order to promote the formation of collateral blood supply.
• Stage 2 (at 6 months): Descent of the testis into the scrotum is done once collateral circulation has been well established. 

Postoperative Care

• Hospitalisation: 1–2 hours.
• Pain control: Mild pain, oral analgesics.
• Wound care: Incisions should be clean and dry; no tight clothing. 
• Activity: Normal and light activity in 2–3 days; no strenuous play or sports for 2–3 weeks.
• Follow-up: Regular examinations to confirm testicular position and viability.

Bilateral laparoscopic orchidopexy for undescended testicles

Laparoscopic orchidopexy, while established in the treatment of unilateral impalpable testis, is somewhat novel when dealing with the contralateral testis in patients with bilateral undescended testis. Both testes normally move down from the abdomen or groin into the scrotum at birth and in this condition, they don’t. The laparoscopic technique enables the surgeon to find, free, and locate each testicle in a safe and efficient manner with very little pain or scarring.

Purpose of Surgery:

The objectives of bilateral laparoscopic orchidopexy are to

• Bring both testes down into the scrotum.
• Maintain the chances of fathering children and producing testosterone.
• Decrease the risk of testicular cancer and torsion.
• Allow for the testes to be more easily felt and monitored in the future.

Laparoscopic orchidopexy recovery bilateral

The bilateral laparoscopic orchidopexy recovery is typically uneventful cure for adults and will require an extended recovery time due to the surgery being minimally invasive. As both undescended testes are managed in the same surgery, thorough post-surgical care is required to ensure proper healing and optimal testicular performance.

Immediate Postoperative Recovery

• Hospital Stay: Usually 1 to 2 days after surgery.
• Observation: Vital signs, urine output, and pain assessment.
• Controlling Pain: Mild to moderate pain tolerated with oral/IV analgesics. 
• Diet: Clear liquids are begun a few hours postoperatively, with a full diet as tolerated.
• Weight Bearing: Patients are advised to mobilize on the first postoperative day.

Recovery at Home (Days 1 to 14)

Pain and Swelling

• Aching and tenderness in the lower abdomen and scrotum is normal.
• There can be swelling or bruising in the scrotum, but it will go away in about a week.
• Cold Packs (if recommended by the surgeon) may help relieve swelling.

Care of Wounds

• Make sure that your incision is clean and dry.
• Wear loose fitting clothing; cotton underwear.
• Don’t use powders, creams, or ointments unless directed.
• Stitches are generally absorbable, so they do not need to be taken out.

Activity Limitations

• You can have light activity after 2–3 days.

Don't:

• No running, jumping, biking, or roughhousing for 2 to 3 weeks.
• Carry anything heavy.
• Older kids and adults go back to school or work in a week (if it’s not too strenuous).

Bathing

• Sponge bath for 2 days.
• Normal baths at 48 to 72 hours when the doctor says the wounds are dry.

Diet

• Return to your regular diet as tolerated.
• Above all, encourage hydration and high-fiber foods to help keep things moving so he won’t risk straining at the stitches.

Best hospital for bilateral laparoscopic orchidopexy India

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

Benefits of bilateral laparoscopic orchidopexy

Bilateral orchidopexy for  intra-abdominal undescended testis is suggested by some surgeons. This transperitoneal approach is currently regarded as the standard of care in bilateral orchidopexy, especially when the testes are impalpable or are located in the abdomen. 

• Minimally Invasive Technique
• Superior Visualization
• Both Sides Can Be Corrected in the Same Operation
• Less Pain and a Shorter Recovery Period
• Reduced Risk of Complications
• Better Testicular Function Preservation
• Diagnostic and Therapeutic Value
• Improved fertility and prevention of cancer
• Excellent Cosmetic Results
• Short Hospital Stay and Quick Return to Normal Life

Conclusion

Laparoscopic orchidopexy is a feasible, effective, and safe operation with minimal complications and good cosmetic outcome for the treatment of bilateral UDT. With the aid of advanced laparoscopic technology, surgeons are able to precisely locate, mobilize and bring both testes down to the scrotum with minimal discomfort and maximum accuracy. The operation not only re-establishes normal testicular position and function, but it also is important in preserving fertility, reducing risk of testicular cancer and improving cosmetic and psychological sequelae. An early (preferably between 6 and 18 months of age) intervention by an experienced pediatric or urologic surgeon will result with a high success rate (90–95%) a quick recovery and benefits that will last a lifetime for reproductive and hormonal health.

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FAQ

1. Can the testicles function normally after surgery?

• In most cases, yes. In early cases, both testicles generally are able to grow up and function normally, although they usually lose one sperm-producing function.

2. Can it be performed in adults?

• Yes, but the best results are obtained with early surgery (as an infant or young child). In adults, the concerns may also be cosmetic correction and testicular salvage.

3. Will there be scars?

• No big scars—just tiny incision marks measuring 3 to 5 millimeters that fade over time, yielding great cosmetic results.

4. How successful is the procedure long-term?

• When the procedure is done early and followed with appropriate surveillance long term results are excellent. The testes usually remain normal size, function, and location throughout life.