Staged laparoscopic orchiopexy of intra-abdominal testis: Spermatic vessels division versus traction?

Infographic · Jun 2024 · 2 min read

In brief

Multicenter study comparing two laparoscopic techniques for intra-abdominal testis: traditional Fowler-Stephens with vessel division versus newer Shehata traction method. Both achieved similar scrotal positioning (81-85%) and atrophy rates (10-13%), but Shehata preserves testicular blood supply and requires shorter interval between stages.

Spermatic vessel traction (Shehata technique) achieves 85% scrotal positioning with 10% atrophy, comparable to Fowler-Stephens.
Traction technique preserves testicular vascularization and requires shorter interval between stages (2.3 vs 6.1 months).
Both techniques show similar long-term outcomes; traction may offer better future spermatogenesis by preserving blood supply.
Traction collapsed in 21% of cases but required redo in only 1.3%, suggesting acceptable salvage rate.
Long-term endocrine and exocrine function assessment after puberty needed to definitively compare techniques.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with illustrated diagrams of surgical procedures. Each column contains a procedural illustration at the top, followed by statistical data presented in colored blocks. The left column uses blue tones, the middle uses green, and the right uses purple/pink accents. Icons and percentage bars visualize outcome metrics below each procedure diagram.

New infographic by Dr. Jose Campos & the Chilean Society of Pediatric Surgeons,

"Staged laparoscopic orchiopexy of intra-abdominal testis: Spermatic vessels division versus traction? A multicentric comparative study"

Authors: Valeska Bidault-Jourdainne, Nathalie Botto, Matthieu Peycelon, Elisabeth Carricaburu, Pauline Lopez, Arnaud Bonnard, Thomas Blanc 6, Alaa El-Ghoneimi, Annabel Paye-Jaouen

Full article: https://pubmed.ncbi.nlm.nih.gov/38310033/

Abstract

Background: Staged laparoscopic management of intra-abdominal testes using pedicular section is recognized as gold standard technique, successful in 85 % of cases for scrotal testicular position with less than 10 % testicular atrophy. Recently, Shehata proposed a new technique without pedicular division for these testes, using spermatic vessels traction, but did not provide a comparative study of the two techniques.

Objective: To evaluate the laparoscopic spermatic pedicular traction (Shehata technique, ST) for the treatment of intra-abdominal testis, as an alternative to gold standard pedicular section (2-stage Fowler-Stephens, FS).

Study design: Intra-abdominal testes of 129 patients in two tertiary pediatric urology centers were managed laparoscopically (2011-2019) either by 2-stage FS orchidopexy or ST according to the surgeon preference. Testicular position and size were statistically compared.

Results: A total of 147 testes were pulled down by 80 ST and 67 FS, including 18 bilateral cases. Median (IQR) age at surgery was 24.2 (15.6-46.4) months (ST) and 18.3 (13.1-38.2) months (FS) (p = 0.094). Scrotal pulling-down of the testis was performed after a median (IQR) period of 2.3 (1.6-3.4) months (ST) and 6.1 (4.7-8.3) months (FS), respectively (p < 0.005). Although ST had collapsed in 17 cases (21.3 %), only one (1.3 %) redo procedure was required. After a median (IQR) follow-up of 22 (12-40) and 19 (8.75-37) months (p = 0.59), the testis was in the scrotum in 85 % and 81 % of ST and FS cases, respectively (p = 0.51). Testicular atrophy occurred in 10 % of ST and 13.4 % of FS (p = 0.61). Multivariate analysis using the propensity score analysis did not identify any difference between the two techniques.

Discussion: Our results seem to confirm that FS and ST achieve the same results regarding final testicular position and testicular atrophy rate, with a long-term follow-up. Our study supports pediatric surgeons to favor laparoscopic spermatic pedicular traction (ST) which preserves the testicular vascularization and may ensure better spermatogenesis after puberty. More details on the size and position of the testicle at the beginning of the first laparoscopy seem however essential to assess more accurately the outcomes of each surgical technique. Our outcomes will also be re-evaluated when our patients have reached puberty, from an exocrine and endocrine points of view.

Conclusions: This study showed similar results after laparoscopic traction or section of spermatic vessels for intra-abdominal testis in a long-term follow-up, providing more evidence for the use of ST as a valuable alternative to FS.

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