Montanari E, Trinchieri A, Zanetti G, Rovera F, Nespoli R, Dell'Orto P, Austoni E, Pisani E
Ann Urol (Paris). 1995;29(2):106-12.
The laparoscopic technique has well defined indications for some andrological procedures such as the diagnosis and the treatment of cryptorchidism, but its role remains controversial in varix ligation for which laparoscopy is however the newest development. At the Institute of Urology of the University of Milan from January 1992 to June 1994 five adults patients with undescended and unpalpable testis underwent laparoscopy. In 4 cases laparoscopic orchiopexy (2 direct and 2 staged procedures) and in one case laparoscopic orchiectomy have been performed. In the same period 20 cases of varicocele (6 bilateral) have been observed and treated by laparoscopic varix ligation. For cryptorchidism after the identification of the testis we decide on the basis of parenchimal trophism wheter to perform orchidopexy or orchiectomy. A single step laparoscopic orchiopexy can be performed if the undescended testis is located proximal to the internal inguinal ring and if the mobilization of the spermatic vessels allows it. A Fowler-Stephens staged orchiopexy is indicated for intra abdominal testicle with short spermatic vessels. In the first stage the spermatic vessels are isolated and divided relying on the compensation offered by the deferential and extrafunicular vessels. After six months, once the testis trophism has been ascertained, the testis can be placed in the scrotum. For varicocelectomy the peritoneum is incised at the projection of the spermatic cord from the internal inguinal ring. A blunt and gentle dissection prepares the spermatic vascular bundle, the spermatic artery is identified and isolated and the vein are clipped and divided.(ABSTRACT TRUNCATED AT 250 WORDS)
腹腔镜技术在某些男科手术中有明确的适应证，如隐睾症的诊断和治疗，但在精索静脉曲张结扎术中的作用仍存在争议，不过腹腔镜技术是该领域的最新进展。1992年1月至1994年6月，米兰大学泌尿外科对5例睾丸未降且无法触及的成年患者进行了腹腔镜检查。其中4例行腹腔镜睾丸固定术（2例直接手术和2例分期手术），1例行腹腔镜睾丸切除术。同期观察并治疗了20例精索静脉曲张患者（6例双侧），采用腹腔镜精索静脉曲张结扎术。对于隐睾症，在确定睾丸位置后，根据实质营养状况决定进行睾丸固定术还是睾丸切除术。如果未降睾丸位于腹股沟内环近端且精索血管能够游离，则可进行单步腹腔镜睾丸固定术。对于精索血管短的腹腔内睾丸，建议采用Fowler-Stephens分期睾丸固定术。第一阶段，依靠输精管和精索外血管的代偿作用，分离并切断精索血管。6个月后，确定睾丸营养状况后，可将睾丸放入阴囊。对于精索静脉曲张切除术，在精索从腹股沟内环突出的投影处切开腹膜。钝性轻柔分离显露精索血管束，识别并分离精索动脉，夹闭并切断静脉。（摘要截选至250字）
