Bilateral Robot-Assisted Laparoscopic Orchiopexy for Undescended Testes. 2021

Clark Higganbotham, and Gates Cook, and Adam Rensing
Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Electronic address: Clark-Higganbotham@ouhsc.edu.

To describe our technique for surgically treating cryptorchidism with bilateral robot-assisted laparoscopic orchiopexy. Nonpalpable, undescended testes are commonly seen by the pediatric urologist. It is recommended to surgically bring the testis into the scrotum early in life to decrease the higher risk of future testicular carcinomas seen in abdominal testes. Diagnostic laparoscopy with laparoscopic orchiopexy for viable, intraabdominal testes is the current standard of treatment. After confirming viable, intraabdominal testes with diagnostic laparoscopy, we used an umbilical camera port and docked the robot with two additional 8-mm ports one handsbreadth to the right and left of the umbilicus. We first mobilized the right testis due to its more proximal location. We incised the gubernaculum distally, and then dissected the vas deferens medially. We carried this mobilization to the left side and mobilized the left testis in a similar fashion. After incising the peritoneum and confirming adequate testicular laxity, we made two transscrotal incisions and pulled either testis into its respective hemiscrotum with a laparoscopic grasper and placed them into a subdartos pouch. This technique demonstrated that robot-assisted laparoscopic orchiopexy is feasible when treating cryptorchidism. This is most applicable at institutions that already have robotic surgery capacity and are comfortable operating robotically. Limitations include that use of the robot usually increases the operative time and therefore length of anesthesia for the patient. There does not appear to be a significant difference in cost associated with robotic versus laparoscopic orchiopexy at our institution, though this may not be the case everywhere. Here we demonstrate successful use of bilateral robot-assisted laparoscopic orchiopexy to treat bilateral undescended testes in a pediatric male. Pediatric urologists can consider using this technique instead of traditional laparoscopic orchiopexy.

UI MeSH Term Description Entries
D008297 Male Males
D010535 Laparoscopy A procedure in which a laparoscope (LAPAROSCOPES) is inserted through a small incision near the navel to examine the abdominal and pelvic organs in the PERITONEAL CAVITY. If appropriate, biopsy or surgery can be performed during laparoscopy. Celioscopy,Laparoscopic Surgical Procedures,Peritoneoscopy,Surgical Procedures, Laparoscopic,Laparoscopic Assisted Surgery,Laparoscopic Surgery,Laparoscopic Surgical Procedure,Procedure, Laparoscopic Surgical,Procedures, Laparoscopic Surgical,Surgery, Laparoscopic,Surgical Procedure, Laparoscopic,Celioscopies,Laparoscopic Assisted Surgeries,Laparoscopic Surgeries,Laparoscopies,Peritoneoscopies,Surgeries, Laparoscopic,Surgeries, Laparoscopic Assisted,Surgery, Laparoscopic Assisted
D003456 Cryptorchidism A developmental defect in which a TESTIS or both TESTES failed to descend from high in the ABDOMEN to the bottom of the SCROTUM. Testicular descent is essential to normal SPERMATOGENESIS which requires temperature lower than the BODY TEMPERATURE. Cryptorchidism can be subclassified by the location of the maldescended testis. Testis, Undescended,Abdominal Cryptorchidism,Bilateral Cryptorchidism,Cryptorchidism, Unilateral Or Bilateral,Cryptorchism,Inguinal Cryptorchidism,Testes, Undescended,Undescended Testis,Unilateral Cryptorchidism,Cryptorchidism, Abdominal,Cryptorchidism, Bilateral,Cryptorchidism, Inguinal,Cryptorchidism, Unilateral,Undescended Testes
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D056126 Orchiopexy A surgical procedure in which an undescended testicle is sutured inside the SCROTUM in male infants or children to correct CRYPTORCHIDISM. Orchiopexy is also performed to treat TESTICULAR TORSION in adults and adolescents. Laparoscopic Orchiopexy,Orchidopexy,Laparoscopic Orchiopexies,Orchidopexies,Orchiopexies,Orchiopexies, Laparoscopic,Orchiopexy, Laparoscopic
D065287 Robotic Surgical Procedures Surgical procedures performed remotely using a computer that controls surgical instruments attached to mechanical arms designed to perform the tasks of the surgeon. Robot Surgery,Robot-Assisted Surgery,Robot-Enhanced Procedures,Robot-Enhanced Surgery,Robotic-Assisted Surgery,Surgical Procedures, Robotic,Procedure, Robot-Enhanced,Procedure, Robotic Surgical,Procedures, Robotic Surgical,Robot Assisted Surgery,Robot Enhanced Procedures,Robot Enhanced Surgery,Robot Surgeries,Robot-Assisted Surgeries,Robot-Enhanced Procedure,Robot-Enhanced Surgeries,Robotic Assisted Surgery,Robotic Surgical Procedure,Robotic-Assisted Surgeries,Surgery, Robot,Surgery, Robot-Assisted,Surgery, Robot-Enhanced,Surgery, Robotic-Assisted,Surgical Procedure, Robotic

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