54692 Laparoscopy, surgical; orchiopexy for intra-abdominal testis

Name of the Procedure:

Laparoscopy, surgical; orchiopexy for intra-abdominal testis

Summary

This procedure involves using a minimally invasive technique to move an undescended testicle from within the abdomen into the scrotum and secure it in place. A laparoscope, a small tube with a camera, is inserted through small incisions to guide the surgeon.

Purpose

The procedure addresses cryptorchidism, a condition where one or both testicles fail to descend into the scrotum. It aims to position the testicle correctly to improve fertility, reduce cancer risk, and enhance the physical appearance.

Indications

• An undescended testicle diagnosed via ultrasound or physical examination
• Recommended for boys generally older than 6 months
• Symptoms include an empty scrotum or the testis located in an abnormal position

Preparation

• Patients are often instructed to fast for 6-8 hours before the procedure
• Medication adjustments may be necessary, including stopping or altering doses
• Pre-operative diagnostic tests, such as ultrasounds or blood tests, may be needed

Procedure Description

1. The patient is placed under general anesthesia for comfort and stillness.
2. A small incision is made in the abdomen, and a laparoscope is inserted.
3. Additional small incisions may be made for surgical instruments.
4. The surgeon locates the testicle and gently moves it into the scrotum.
5. The testicle is secured in the scrotum using sutures to prevent retraction.
6. Incisions are closed with stitches or surgical glue.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Performed in a hospital operating room or a surgical center.

Personnel

• Pediatric or urologic surgeon
• Anesthesiologist
• Surgical nurses
• Possibly a surgical assistant

Risks and Complications

• Infection at the incision sites
• Bleeding or hematoma formation
• Testicular atrophy (shrinkage)
• Incomplete descent of the testicle
• Recurrence of the testicle moving back to the abdomen

Benefits

• Improves fertility potential
• Reduces the risk of testicular cancer
• Provides a normal appearance
• Benefits are often realized immediately after recovery

Recovery

• Most patients can go home the same day.
• Pain management includes oral analgesics.
• Avoid strenuous activities for a few weeks.
• Follow-up appointments are necessary to ensure proper healing and testicular positioning.

Alternatives

• Hormonal therapy (less commonly used and less effective for intra-abdominal testicles)
• Open surgical orchiopexy
• Pros: Non-invasive options may be considered initially
• Cons: May not be effective in all cases, especially for high intra-abdominal testicles

Patient Experience

• During the procedure, the patient is under general anesthesia and will not feel anything.
• Post-procedure discomfort is managed with pain medication.
• Mild soreness and swelling in the groin area are common.
• Gradual return to normal activities over 2-4 weeks.