Video-laparoscopic orchiectomy

A 27-year-old bilaterally cryptorchid patient underwent right testicular autotransplantation in the presence of a quite normal testis. After one year, patency of microsurgical anastomosis was confirmed by means of Doppler flowmetry and scrotal echography demonstrated the presence in the scrotum of a testis with normal echogenicity. Left laparoscopic orchiectomy was planned. A small semilumnar skin incision was made just below the rim of the umbilicus. A Veress needle was introduced: as soon as the needle pierced the parietal peritoneum, its spring mechanism was released allowing the sharp needle point to retract leaving only the blunt tip protruding. Carbon dioxide gas was introduced through the side part of the Veress needle until adequate abdominal distension was achieved. After having removed the Veress needle, the laparoscope, on its sharp-pointed trocar, was introduced into the peritoneal cavity and the left testis was easily localized. Four trocars were introduced to proceed to laparoscopic orchiectomy. The patient was discharged two days after. It is held that in the presence of bilateral cryptorchism in the adult, it is better to plan a monolateral autotransplantation. After having assessed the long-term result of microsurgery a controlateral orchiectomy was planned.