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Laparoscopic lowering of a left intra-abdominal testis

Authors

Abstract

Early diagnosis and management of an undescended testicle is needed to preserve fertility and improve early detection of testicular malignancy. This video demonstrates the laparoscopic lowering of a left testis situated intra-abdominally.

Catégorie

contribution

Mots-clés

Laparoscopic lowering, left intra-abdominal testis

Type de vidéo

Durée

03'02''

Publication

2011-04

Popularité

Favoris

Audio

Sous-titres

E-publication

WeBSurg.com, Apr 2011;11(04).
URL: http://www.websurg.com/doi-vd01en3244.htm

Laparoscopic lowering of a left intra-abdominal testis

1. Introduction 00'19''

This video demonstrates the laparoscopic lowering of a left testis situated intra-abdominally.

2. Patient position and operative setting 00'25''

The child is placed in a supine, frog-like position, at the end of the operating table. The monitor is positioned at the end of the table, facing the child. The surgeon stands to the child’s right because he/she will work at the level of the left inguinal canal. The surgeon would be standing at the child’s left should he/she work at the level of the right inguinal canal. A 5mm optical is placed in the umbilicus, whereas two 3mm instruments are placed on each side of the umbilicus.

3. Closure of vaginalis process 00'56''

To the right, the elements of the cord —vas and vessels— converge towards the deep inguinal ring. The vaginalis process is closed.

4. Opening of peritoneovaginal duct 01'11''

To the left, a long epididymodeferential loop can be seen entering the inguinal canal. The peritoneovaginal duct is opened. The procedure starts with the freeing of the vascular spermatic pedicle. This pedicle will be strictly preserved.

5. Peritoneal division and spermatic pedicle dissection 02'04''

The second operative step will consist in dividing the peritoneum away from the vas in order to free the epididymodeferential loop. The vascularization of the vas is preserved. No electrocautery is used in order to avoid any warm-up of the spermatic cord structures.

6. Forceps introduction and scrotal incision 02'52''

Once the dissection of the spermatic pedicle has been completed, a forceps held along the axis of the left inguinal canal is entered into the inguinal canal to reach the scrotum. A scrotal incision is performed.

7. Forceps exteriorization 03'13''

The dartos pouch is prepared. The forceps is passed through the dartos and exteriorized. The forceps will be used by means of a small ribbon to retrieve another forceps, which is entered in the abdomen using a scrotal, then an inguinal access route.

8. Testis lowering 03'37''

This forceps will help to find the left testis, which has been totally freed, in order to lower it.

9. Closure 03'49''

At the end of the procedure, the peritoneum is closed at the deep inguinal ring using an intracorporeally knotted purse-string.

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