Department of Urology, NYU Grossman School of Medicine, New York, NY.
Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY.
Urology. 2022 Jan;159:255. doi: 10.1016/j.urology.2021.09.020. Epub 2021 Oct 8.
Silber and Kelly first described the successful autotransplantation of an intra-abdominal testis in 1976. Subsequent authors incorporated laparoscopy and demonstrated the viability of transplanted testes based on serial postoperative exams. We sought to extend this experience with use of the da Vinci surgical robot, thereby demonstrating a novel robotic technique for the management of cryptorchidism. The procedure was performed for an 18-year-old male with a solitary left intra-abdominal testis. Following establishment of pneumoperitoneum, the robot is docked with four trocars oriented towards the left lower quadrant. Testicular dissection is carried out as shown. The gonadal and inferior epigastric vessels are isolated and mobilized; once adequate length is achieved, the former is clipped and transected, and the testicle and inferior epigastric vessels are delivered out of the body. The robot is then undocked and exchanged for the operating microscope. Arterial and venous anastomoses are completed with interrupted and running 9-0 Nylon, respectively, and satisfactory re-anastomosis is confirmed visually and with Doppler. The transplanted testicle is then fixed inferiorly and laterally within the left hemiscrotum, and all incisions are closed. We note that intraoperative testicular biopsy was not performed, for three reasons: (1) to avoid further risk to an already tenuous, solitary organ, (2) because our primary aim was to preserve testicular endocrine function, and (3) because the presence of ITGCN would neither prompt orchiectomy nor obviate the need for ongoing surveillance via periodic self-examination and ultrasonography. The patient is maintained on bed rest for two days and discharged on postoperative day seven in good condition. Over one year since autotransplantation, his now intra-scrotal testicle remains palpable and stable in size. Serum testosterone is unchanged from preoperative measurements. Robotic-assisted testicular autotransplantation is a feasible and efficacious management option for the solitary intra-abdominal testis.
西尔伯和凯利于 1976 年首次描述了成功的腹腔内睾丸自体移植。随后的作者将腹腔镜技术融入其中，并通过术后系列检查证明了移植睾丸的活力。我们试图利用达芬奇手术机器人扩展这一经验，从而展示一种治疗隐睾症的新型机器人技术。该手术是为一名 18 岁的左侧腹腔内单睾男性患者进行的。建立气腹后，机器人通过四个面向左下方象限的套管进行对接。按照图示进行睾丸分离。分离和游离精索内动静脉；一旦获得足够的长度，夹闭并切断精索内动静脉，将睾丸和精索内血管带出体外。然后，机器人脱机并更换为手术显微镜。分别采用间断和连续的 9-0 尼龙进行动静脉吻合，通过肉眼和多普勒确认吻合满意。然后，将移植的睾丸固定在左侧阴囊的下方和外侧，最后关闭所有切口。我们注意到，由于三个原因，术中未进行睾丸活检：（1）避免对已经脆弱的单个器官造成进一步的风险，（2）因为我们的主要目的是保留睾丸内分泌功能，（3）因为存在 ITGCN 既不会促使进行睾丸切除术，也不会免除通过定期自我检查和超声检查进行持续监测的需要。患者卧床休息两天，术后第七天情况良好出院。自自体移植以来已经超过一年，他现在的阴囊内睾丸仍然可触及，大小稳定。血清睾酮与术前测量值无变化。机器人辅助睾丸自体移植是治疗孤立性腹腔内睾丸的一种可行且有效的治疗选择。
