Froeling F M, Sorber M J, de la Rosette J J, de Vries J D
Department of Urology, University Hospital Nijmegen, The Netherlands.
Urology. 1994 Feb;43(2):222-7. doi: 10.1016/0090-4295(94)90049-3.
To show the reliability of laparoscopic procedures in case of cryptorchidism. It also shows the growing possibilities of laparoscopic manipulations of the cryptorchid testis obviating in a great percentage the need for open operative procedures.
Starting from the standard diagnostic laparoscopic procedure we gradually extended its use to a full operative procedure. The standard procedure is extensively elucidated in the way we used it in sixty-one laparoscopic procedures for seventy-four non-palpable testes.
All laparoscopies were technically successful. Forty testes (60.3%) were found intra-abdominally. Four testes (5.5%) were found lying in the inguinal canal or in an ectopic position. Twenty-five testes were absent. The diagnosis of a vanishing testis could be established in most of these cases. In the beginning period the following open procedures were done after the diagnostic laparoscopy: sixteen open explorations, ten formal standard orchidopexies; nine orchiectomies, nine autotransplantations, and three Fowler-Stephens procedures. In recent years we proceeded with laparoscopic manipulation, performing eleven laparoscopically assisted orchidopexy procedures (LAOPs), six extended laparoscopic explorations, and two laparoscopic orchiectomies.
Laparoscopy is not only a safe and reliable method in diagnosing the presence of a nonpalpable testis, but also thanks to more sophisticated instruments allows us more and more to perform the complete treatment. It can facilitate the placement of surgical incisions or obviate the need for further open intervention if no spermatic vessels are visualized in the abdomen.
证明腹腔镜手术在隐睾症治疗中的可靠性。同时也显示出腹腔镜操作隐睾的可能性不断增加，从而在很大程度上避免了开放手术的必要性。
从标准的诊断性腹腔镜手术开始，我们逐渐将其应用扩展至完整的手术操作。我们在针对74个无法触及的睾丸进行的61例腹腔镜手术中所采用的标准手术方法得到了详尽阐述。
所有腹腔镜检查在技术上均获成功。40个睾丸（60.3%）位于腹腔内。4个睾丸（5.5%）位于腹股沟管或异位。25个睾丸未发现。在大多数此类病例中可确诊为睾丸已消失。在最初阶段，诊断性腹腔镜检查后进行了以下开放手术：16例开放探查、10例标准的睾丸固定术；9例睾丸切除术、9例自体移植术以及3例Fowler-Stephens手术。近年来，我们采用腹腔镜操作，进行了11例腹腔镜辅助睾丸固定术（LAOP）、6例扩大的腹腔镜探查以及2例腹腔镜睾丸切除术。
腹腔镜检查不仅是诊断无法触及睾丸存在与否的一种安全可靠方法，而且由于器械越来越先进，使我们越来越能够进行完整的治疗。如果在腹部未见到精索血管，它可以便于确定手术切口位置或避免进一步的开放干预。
