1. Laparoscopic Management Of Muataz A. Al Ani , Bassam Kh. Al Abassy
Impalpable Testes
In Pediatric Age Group
Muataz A. Al Ani , Bassam Kh. Al Abassy
Pediatric Surgeons

2. Introduction
Cryptorchidism is a common finding in pediatric practice ,

3. 21% of preterm male infant.
1.8-4 % of full term boys.
0.8% of 1 year old boys.
The proportion of impalpable testis has been reported up to 20% of all cryptorchied boys.

4. A variety of imaging modalities have been used to detect the impalpable testis,
Ultrasound, Computed tomography, Magnetic resonance imaging, Arterography and venography.
Non are as sensitive as laparoscopy for accurate localization of the intra abdominal testes.

5. Cortesi et al first reported the use of laparoscopy in the surgical management of impalpable testes in 1976.
Initially, laparoscopy was used only for localization before open surgical exploration. It is only recently that laparoscopy been deemed a means of both diagnosis and treatment.

6. Aim Of The Study The purposes of our study was:
To evaluate the role of laparoscopy in localizing impalpable testes.
The management strategy for both unilateral and bilateral impalpable testes .

7. Patients And Methods
Throughout the period between January 2005 to December 2008 ,
A 36 patients with impalpable testes were admitted to the pediatric surgery centre at Al khansa teaching hospital in Mosul /Iraq ,
Laparoscopy done for them to assess and manage 42 impalpable testes.

8. Ports 5-10 mm supra-umbilica port for 0ºtelescope
For diagnostic laparoscopy:
at least an additional port is needed.
For therapeutic management:
additional 2 working ports in the flanks.

9. Result And Discussion Intra Canalicular Testes
Intra abdominal testes are classified according to the laparoscopic findings
Intra Canalicular Testes

10. Intra Abdominal Testis Are Classified According To The Laparoscopic Findings

11. Intra Abdominal Testis Are Classified According To The Laparoscopic Findings
vanished testes

12. Teratoma

13. Persistent Miillerian Duct Structures

14. A viable intra-abdominal testis
The limiting factor to relocate the intra-abdominal testis to the scrotum is
the length of the gonadal vessels.
Assisted laparoscopic orchiopexy.
Single stage Fowler-Stephen technique.
Two stage Fowler-Stephen technique.

15. Result And Discussion 36 PATIENTS (42 IMPALPABLE TESTES)
27 Testes Were Positive
15 Testes Absents
Vanished Testes
12 Vas And Vessel Enter The Internal Ring
3 With No Vas And Vessel Entering The Ring (Agenesis).

16. 27 Testes Positive 16 Near The Internal Inguinal Ring
2 Testes Intra Canaliculare
9 In The Iliac Fosse
Assisted laparoscopic orchiopexy
Single stage Fowler-Stephen technique in 4 testes
Two stages Fowler-Stephen technique in 2 testes
Biopsy In 3 testes

17. Assisted Laparoscopic Orchiopexy Condition Of The Testis
We followed our patients for about two years by assessing the size of the fixed testis in comparism to the other one and in relation to patient age. %
F. S Procedure
Assisted Laparoscopic Orchiopexy
Condition Of The Testis 75 5 13
Good size
21.8
1 one stage 4
Small size
4.2 1
Atrophy
100 6 18
Total

18. Conclusion
laparoscopy has a safe, reliable and accurate role in management of impalpable testis .
It also direct the surgeon to chose the proper technique for orchiopexy .
One stage assisted laparoscopic orchiopexy.
Single stage Fowler Stephen laparoscopic orchiopexy .
Two stages Fowler Stephen laparoscopic orchiopexy.

19. Thank you