Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
Urology. 2021 Feb;148:314. doi: 10.1016/j.urology.2020.10.044. Epub 2020 Nov 12.
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.
描述我们采用双侧机器人辅助腹腔镜隐睾固定术治疗隐睾的技术。
小儿泌尿科医生常遇到无法触及、未下降的睾丸。建议在生命早期通过手术将睾丸移入阴囊，以降低在腹部睾丸中看到的未来睾丸癌的较高风险。对于有活力的腹腔内睾丸，诊断性腹腔镜检查结合腹腔镜隐睾固定术是目前的治疗标准。
在诊断性腹腔镜检查确认有活力的腹腔内睾丸后，我们使用脐部摄像端口，并在脐部右侧和左侧各 1 英寸处的两个额外的 8 毫米端口对接机器人。我们首先由于其更靠近近端的位置而移动右侧睾丸。我们在远端切开提睾肌，然后在内侧分离输精管。我们将这种动员转移到左侧，并以类似的方式动员左侧睾丸。在切开腹膜并确认睾丸有足够的松弛度后，我们做了两个经阴囊切口，用腹腔镜抓钳将任一睾丸拉入其相应的半阴囊，并将其放入一个 Dartos 囊袋中。
这项技术表明，当治疗隐睾时，机器人辅助腹腔镜隐睾固定术是可行的。这在已经具有机器人手术能力并且能够熟练操作机器人的机构中最为适用。局限性包括机器人的使用通常会增加手术时间，从而延长患者的麻醉时间。在我们的机构中，与机器人相比，腹腔镜隐睾固定术的成本似乎没有显著差异，但这可能并非到处如此。
在这里，我们展示了成功使用双侧机器人辅助腹腔镜隐睾固定术治疗小儿男性双侧未下降的睾丸。小儿泌尿科医生可以考虑使用这种技术代替传统的腹腔镜隐睾固定术。
