No.3 June 200 Vol.11 pp.145-216 itort-in-hief A. Holsehneder Kol Yeon, ars Coordinating Ete 1 Pro, Vencoeuore les Nancy Associated Eaitors NMA. Gox. Useehe I Bayidparncn,Ankare Daum Heldebere *R Debnetes Grains Demin: Bologna 1 Farin zapreb Rf Hogerld Dublin BLE Keramidse Athen EN Marne Ubon .atenaral Innsbruck Lit Nielsen, Copenhagen nino Facets Pei 1. Sauter, 28cch J Ro Maced Catach claszow Fespnsible forthe United ‘Kingdom NSA Philadelphia Response for Usa Gartman, Montel Responsible or canada Nhat ot Ferpanibe for Aa Rode Ronceboreh Responsible for South ia Special Eatorial Consultants General Pediatrie Surgery “Bain, Torna A Bensoussan Montréat R MeFi Torome J) LerestIndlanapois 1. MaGoys, arseite [ AHalls,satmore Wk Hendren Boson Baroy. esl 1 Jeppcn aneen Kalish, Wasa T kamu, Taye TL Tarsen, tana I iste edinburgh P,Du os, verpoot K I t % R Maruti, Genova Mau, Sein Malena Rocentam isen. Uppsala Pte Pes ‘Shver Ga Dive sehwenic Basel P, Schweizer, Tubingen RG. Sehwobel Luesn 2. Ure, Hannover 1 Waisehmit Bertin 1, Wester, Upsala Yasbek Manuel Dever abel 1 Yokejam Tokyo Pediatrie Anesthesiology Meyer. Pars B.tibboe Roserdam + Embryology and Morphology PH. Bure Ber iki Harbure European Journal of 3 Pediatric ratholgy |. Brine Aarau b.strms il PeRuck Tsnges Organ Transplantation 4 2.06. Brussls Fe Reeing Brssels Pediatric Neurosurgery 1. Cams, Genova R Gamtirela Cala Pediatrie Oncoloay J Micha. Pans Nga Zurich .Semmetet, ‘Vandoeuvre Nancy Pediatric Railoay ‘couture Montpelier chen Hamburg Pesaeis Kura, Graz Pediatric Traumatology L RE won tae Basel Pediatric Orthopedics IN. Bergoui, Marsele Pediatric Urology 1G Dies then F, Mourigeand ton Soham ote Pediatrie Paste Sure Ver, Pavia (Official Journal ofthe following Associations ot Became Srgery Austian Mish Began Talla Cooasan Portuguese Dutch” Seandinavan French Spanish German Swiss Greek Turkish Sodofthe EUPSA (European Union of Peeiate Sores Assocons) ‘and UEMS Union of xropest Media Specs ~ Section of Pecatiesurgen) ur) Pediay Surg, ISSN 0038-7248 ‘Georg Thieme verlag Rosigerase 14 70408 Sugar “Teme New York = 333 Seventh Avenue New York NY 10001 asson Ever Paris (Ppa ance: 72-8740 epg: 6974 rede vente anno: 368 FF Pediatric Surgery Original Articles 147 Kaschke. 0, H.Oze, | Sandmann Use of Cartilage Grafts in the Treatment of Laryngotracheal Stenases and Defects in Childcen 154 Adio, G,C Pintus, L Revell . Grotesi,P Modugne, CC vincenzoniG.Fadde. L Perel “Thyroid Tumors in Children and Adolescents: Preoperative Study 8 Emir HM, Akan, A. Bele, K. Gumus. ¥ Soyer Isntesina Ischemia a Risk ef Laparoscopy? ‘An Experimental Study in Rabbits 163 Kobayashi H, K, Horikoshi, A Yaratoke, 7 Okazaki, G | Lane T Miyano, H Kawarasaki, M Mokuuchi Urinary Trypsin Inhibior and Bilary Atresia ~ Providing Protection forthe Liver? 167 Akisu M, Flohr Girgin, M. Baka, A. Hlsseyinow, Ni. Kulersay ‘The Role of Recombinant Human Erythropoietin in Lipid Peroxidation and Piatelet-Acivating Factor Generation in a Rat Model of Necrotizing Encerocalitis 73 Hamca, A. F.M, Elahim, 0, Hnagar, S.A, Maaty, 1 E. Bossiouny, B.Jehannin ‘Testicular Descent: When o Interfere? 177 Topuzlu Tekant, Gy H. Er, Eroglu, M.Akman, .Bayktna, IN.Danigmend, ¥- stylet Experience with Laparoscopy in Nonpalpable Testis 4382 De Backer A, P.Erpicum, Philippe, M. Demarce, 8. Otte, IK. Schwagten M. Vandelanotte, M, Doc, T. Rose, A Verhelst, . De Caluwe,P,Deconinck SaerococcygealTeratoma: Results of Retrospective Multicentrie Study in Belgium and Luxembourg 186 Jacquier,C, E Dobremez, C.Proat, -F. Dyon, F. Nugues ‘nal Canal Duplication in Infants and Children ~ A Series of6 Cases 4192 Arana, J. A. Villanueva, R, Guarch,PAldazabal, M, Barvola “Anorectal Area. An Experimental Model in the Rat Case Reports 196 Federicsivana,V. DomenichllC. Tani ita Scut, Roberta Burneli.C. Zonet R. Domini Pleuropulmanary Blastoma in Congenital Cystic Adenomatoid Malformation: Report ofa Case 200 All, S, W. Nasr ‘Multiple ipsilateral Congenical Diaphragmatic Pathologies: Rarities to Consider 204 Pressman, AB. Kawar,M, Abend. Steiner, G. Mogiiner ‘Acute Perforated Neonatal Appendicitis Associated with Chorieamnionits 207 Agarwal S.A. K. Hemal, A. Seth, A. K Gupta, ¥. Bhatnagar, DK Mira “Transitional Cell Carcinoma of the Urinary Bladder Following Exposure to Cyclophosphamide in Childhood Information 2M Peril G.B. R Coraci, 2, Zachariou, UEMS Section of Paediatric Surgery Paediatric Surgeons Websurfers Bulletin ‘216: Congress Announcementsee OFigindl Article eammmcmeme eC 177 Experience with Laparoscopy in Nonpalpable Testis G. Topualu Tekant, H. Emir, €. Eroglu, M, Akman, Cenk Blyikiinal, N. Danismend, ¥. Séy Department of Paedie Summary ‘Aim: The aim of this stidy was to investigate the feasibility and benefits of diagriosis and interventional laparoscopy in those paediatric patients with nonpslpsble testes (NPT), Patients and Methods: Between 1992 and 1999, 75 patients with NPT (mean age 3 years, range 6 months to 14 years) were treated. 86 testes were evaluated, Results: According to the laparoscopic findings 4 groups of testes were identified: Vanishing tests (n= 32), low abdominal testis (<2cm to the intemal ring) (a=26), high abdominal tes- tis (2cm to the internal ring) (n= 2¢) and intersex patients (1=4). OF the first group, 19 testes (one bilateral) had blind- tending spermatic cord and vessels and i an atrophic testicular ‘issue was identified, it was removed laparoscopically, For ‘those with spermatic cord andl vessels beyond the internal ring (13 testes), atrophic testes were remaved through a high sero- tal incision. 19 testes of the second group had a laparoscopy 25 sisted orchidopexy. In the same group a laparoscopic orehido: Peay wes performed on 7 testes, 24 testes in the 3rd group had 32 Fowler-Stephens (FS) stage 1 and 18 testes had a laparotomy performed for FS stage 2 procedure (laparotomy and orchid pexy) after 6 months, At laparotomy there was no evidence of testicular atrophy in all but one testis, which was remaved and the F5 stage 2 procedure was completed in 17 testes, The fol- low-up period was between § months and 4 years, and two ‘more testicular atrophies were nated after FS stage 2. The re= sults were satisfactory in 15 out of 18 testes (83%). Inthe inter- sex group, the patient with testicular feminization underwent laparoscopic orchiectomy. The other patient with bilateral nonpalpable testis was identified as having an uterus and two intraabdominaly located gonads on laparoscopy and gonadal biopsies were obtained for diagnosis. Histology demonstrated bilateral ovotestes, confirming the diagnosis of a true hermaph- rodite. Conclusion: We are of the opinion that laparoscopy decreases the numberof laparotomies in NF, allows a single-stage proce- ure in tow abdominal testis, and facilitates clip igation of the testiclarartery in high abdominal tests. Laparoscopy also pro- ty, Istanbul University. stanbul, Turkey Vides diagnostic and therapeutic options for vanishing testis, and intersex patients, 1 Key words: Tests - Laparoscopy ~ Cryptarchidism Resumé But: Le but de cette étude était d'apprécier [a fasabilité et le bénéfice de la laparoscopie diagnostique et interventionelle chez les patients avec des testicules non-palpés (NPT) Patients et Méthodes: De 1992 4 1998, 75 patients avec NPT (2ge moyen 3 ans, § mois 8 14 ans) étaient traftés, 86 testicules ftaione valués, Résultats: En fonction des découvertes de la laparoscopie, 4 groupes de testicules était identifies: le testicule dispara (1=32), le testicule abdominal bas (« de 2em de anneau in- {uinal (n= 26}, le testicule abdominal haut (> de 2em de an ‘eau inguinal) (n= 24) et le groupe Intersexe (n= 4) Dans le premier groupe, 19 testicules (un bilateral) e présentaient avec lune terminalson borgne du cordon spermatique et des vais- seauxet, si une atrophie testiculaire était observée, le testicule tat enleve. Parmi ceux avec un déférent et des vaisseaux des cendant en dessous de loifice inguinal interne (13, les teticw les atrophiques étaient enlevés a travers une incision serotale haute, 19 testicules du seconé groupe subissaient une orchide- erie videorasistée. Dans le méme groupe, une orchidopexie etait rélisée sur 7 testicules. 24 testcules du groupe 3 subis- saient un Fowler-Stephens (FS) en un temps et 18 un FS en deux temps. Au moment de I'abaissement aucun des testicules sauf tun ne présentait d'atrophie et le deuxiéme temps était réalisé Pour 17 testcules. Le suivi post-opératoire était de 6 mois 8 4 ‘ans, deux atrophies testculaires supplémentaires étafent no t€es. Les résultats sontsatisfaisants sur 15 testicules parmi 18 (83%). Dans le groupe intersexe, le patient avec un testicule fe ‘minisanta subi une orchidectomie laparoscopique. Uautre pa- tient avec un testicule bilatéral non-palpable avait un utérus et deux gonades intra-abdominales: sous laparoscopie des biop sies gonadiques étaient réalisées. Uhistologie mettait en évi- dence des ovotestis confirmant le diagnostic d hermaphrodite ur] Pediatr Surg 2001; 7177-181 ‘Georg Thieme Verlag Seuttgar, New York- Masson Editeur Paris ISSN 0939-7248 iii iii ci it Received: November, 1989Eur | Pediatr Suro 2007 _ conclusion: {a laparoscopie diminue le nombre des laparato- fies cher les NPT. permet un abaissement en un temps pour Fes testicules abdominaux bas situés et un clipage facile des onseaur pour les testicules hauts situés. La laparoscopie per net aussi un diagnostic et un geste thérapeutique pour les tes: trcules disparus et pour les patients ambigus. tm Mots-clés: Testicule ~Laparoscopie ~ Cryptorchidie Resumen LObjetivo: Este estucie pretende investiga le Factbilidad y los beneficios de la aparcscopie diagnéstica y terapéutica en pa- cientes con testiculos no palpables (NPT), Pacientes y métodos: Entre 1952 y 1989 tratamos 75 pacientes con NPT (edad medie 3 afos, rango entre 6 meses y 14 aos). Evaluamas 86 testiculos, Resultados: Segin los hallazgos laparoscopicos identificamos & (grupos de testiculos: evanescentes (9 =32), abdominales bajos (€Zem del ailla inguinal intema) (n= 26), testiculos abdomi rales altos (»2.¢m por encima del anillo interno {n= 24) y pe ‘Gentes intersexules (9=4). En el primer grupo 19 testiculos (1 bilateral) tenian corcén espermatico terminado en muiién y cuando se encontr6 tejido testicular atrofico se extirpd. Em aquellos con cordon espermatic y vasos mas alla de la hernia, inguinal (13 testiculos) se extieparon testiculos atroficos a tra- vvés de una incisin escratal alta 19 testiculos del segundo gru~ po sufrieron una orquidopexis asstida por laparoscopia. En el mismo grupo se realizé orquidopexia laparoscépica en 7 tes- ticulos. 24 testiculos en el 3 grupo se trataron mediante un pri- mer tiempo de Fowler Stephens (FS) y 18 testicles se trataron ‘mediante laparotomia para 2 tiempo de FS tras 6 meses. En lo laparotomia no hubo evidencia de atrofia testicular excepto en tun gonada que fue extirpada y se camplet6 el segundo tiempo del FS en 17 casos. El periodo de seguimiento es entre 6 meses 4 afos y se encontraron dos atrofias testiculares mas tras 2° tiempo de FS. Los resultados fueron satisfactorios en 15 tes- ticulos de 18 (23%) Enel grupo intersexo un paciente con femi- rizacion testicular requirié orquidectomia laparoscépica. Otro con testiculos no palpables tenia utero y dos qénadas intraab- 2em obechalb des inneren Leistenringes. n= 24) und Intersex-Patienten (n"4). Bei der ersten Gruppe der Pe tienten zeigten 9 Hoden {einer bilateral) einen blindendenden Samenstrang sowie blindendende Gefafe. Atrophisches Hoden- {gewebe wurde wahrend der Laparoskopie entfernt, Bei Patien: fen, bei denen rudimentare Samenstranggebilde unterhalb des Leistentings entdeckt wurden (73 Keimérisen). wurden die atrophischen Reste mittels einer hohen skrotalen Inzision ent fern. Bei 19 Hoden der 2weiten Gruppe wurde eine laparosko- pisch assistierte Orchidopexie durehgefulrt. In derselben Grup- pe wurde eine laparoskapische Orchidopexle bel 7"weiteren Keimérusen vorgenammen. 24 Hoden der driten Gruppe wur den nach Fowler Stephens einzetig sowie 18 Hoden zweieitig operiert, wobei der zweite Eingriff sechs Monate spater er folgte. Bei der Laparotomie wurde nur bel einem Hoden dieser Gruppe eine Hodenatraphie bemerkt und der Hoden entfern. Der Nachuntersuchungszetraum lag zwischen 6 Monaten und 4 Jahren. wobei zwel weitere Hodenatrophien nach zweizeitr tgem FowlerStephens-Vargehen beobachtet wurden. Insge- Sam konnten bei 15 von 18 s0 verlagerten Hoden (83%) befrie digende Esgebnisse erzelt werden. in der intersex-Gruppe wur- de bei einem Patienten mit testikulscer Feminisierung eine la paroskopische Orchidelomie durchgefuhr, Bei einem weite Fen Kind mit beidseitigem, nicht tastbaren Hoden fand sich ein Uterus und zwel intraabdominell gelegene Gonaden. Hier wur- den Biopsien entnommen, die beidseitige Ovotestes im Sinne tines echten Hermaphroditmus ergaben, Schlussfolgerungs Wir sind der Ansicht, dass die Laparoskopie die Anzahl der Laparotomien bei Kryptorchismus herabsett. Bei tiefliegenden Hoden kann einzeitig der Hoden in das Skro- ‘tum verlagert werden, wirend bei hoher Lokalisation die tige tur der Arteria testiculars dle spatere Verlagerung vereinfacht. Dardber hinaus erlaubt die Laparoskopie dlagnostische und therapeutische MaBinahmen im Hinblick aut die spontan 2 ‘ekgeblidete Keimdrise und Intersex-Patient. I Schlisselworter: Hoden ~ Laparoskopie ~ Kryptorchismus Introduction ‘The incidence of cryptorchidism is 0.8 percent at 1 year of age and 20 percent ofthese children have nonpalpable testis (NPT) that are presumed to be located within the abdominal cavity (6.16) The first challenge is to determine whether the testis is ‘even present and, ifs, where it is located, After Cortsi et al's first description ofthe use of laparoscopy forthe localisation of ronpalpable testis, its use has become increasingly popular (1.2.21), Although ultrasonography, computed tomography land venography have been used, laparoscopy is the most reli- able method in confirming the presence of an intra-abdominal testis (6,10,11) In addition to diagnosis, laparoscopy has also been used successfully to pesform both orchiopexy and orehi- cectomy (4.12). With this report we present our experience in lssessing the role of laparoscopy in dlagnosis and manage tment of nonpalpable testis wich the indication given by acon- sultant paediatric surgeon, after examination of the patient both before and after induction of anaesthesia.Experience with Laparoscopy in Nonpalpable Tests Patients and Methods Berween years 1992 ané 1999, we perform: 75 patients for the diagnosis ang treat lateral or bilateral, 85 testes were examined and th of the patients was 3.0 years (range: 6 months - 14 years). OF these NPT cases, 64 were unilateral and 11 were bilateral, We employed the following laparoscopy technique. The bladder was eatheverised under general anaesthesia and a nasogastric tube was placed in all patients, A Veress needle was inserted {or insufflation through an intraumbilical incision, After pnew- moperitoneum was achieved with a pressure of approximately iMemH,0, a 5 or 1mm trocar (in some cases a needlescope) was inserted and a pelvioscopy was carried out using a 5~ TOmm scope. The abdominal cavity was frst examined in the ‘Trendelenburg pasition to detect any possible injury to the bowel of organs. Inspection started with particular attention to testicular location and che presence of processus vaginalis. If a vas déferens with an apparently normal appearance and ‘vessels were seen entering the internal inguinal ring, pressure ‘on the inguinal region sometiniesallowe6 the visualisation of the peeping testis. If an intra-abdominal or peeping testis was ‘observed, another 5 mm trocar was placed in the lower quad rant ipsilaterally tothe testis. By the grasper inserted through the second tracar, the ubernacular attachments were grasped and tractioned to evaluate the distance of the testis from the internal ring. IFthe distance was ess than 2cm and the tests, ‘gave the impression that it was sufficiently mobile with no ‘vascular impairment, 2 laparoscopy-assisted of laparoscopic orchiopexy was attempted. If the distance was more than 2em, a Fowler-Stephens (FS) stage 1 procedure, in which the testicular artery is clipligated, was performed. Six months after the initial procedure, he FS stage 2 procedure including laparotomy and surgical orchiopexy was performed. In the ab- sence of testis, the spermatic cord and the vessels were traced, If they were beyond the intemal inguinal ring, atrophic testes ‘were removed through a high scrotal incision. If blind-ending spermatic cord and vessels were found intra-abdominally, the atrophic testicular tissue was removed laparoscopical¥. laparoscopy on im a testicular feminization case, laparoscopic orchiectomy ‘was performed and in another true hermaphrodite case with identified uterus, gonadal biopsies were obtained. Results ‘According to the laparoscopic findings 4 groups of testes were identified: vanishing testis, law abdominal testis (< 2m to the internal ring), high abdominal testis (»2¢m to the intemal ring) group and intersex patients. There were 32 vanishing testes, 26 low abdominal testes, 24 high abdominal testes and 4 testes in the intersex group (Table 1). OF the first group, 19, testes (one bilateral) had blind-ending spermatic cord and ves- Groups 1 Vanishing testis dgenesis group 3 2: Low abdominal tests (<2em tothe intemal ring) group 22 3: High abdominal esis (@2em to theInteral ring) group 20 4: Intersex patents grain 2 Total 5 Woof patients No.of testes Eur Pediatr Surg 2001; 11 $179) sels: iTthere was atrophic testicular tissue, it was removed lap~ froscopically. thus preventing an unnecessary laparotomy. For those with spermatic cord and vessels Beyond the internal ring (13 testes), atrophic tesces were removed through 3 high scro- tal incision. The histolagical examination demonstrated fi- brous tissue without any germ cells in all eases. 19 testes of, the second group had a laparoscopy-assisted orchiopesy. In the same group a laparascapic orchiopexy was performed on 7 testes. The major surgical problems encountered in these p tients were injury tothe testicular vessels and techaical dif fultes related to our learaing curve. These were observed in 2 patients, whose testes decreased in diameter postoperatively. 24 testes in the 3rd group had a Fowler-Stephens (FS) stage 1 land 18 testes hada laparotomy performed for FS stage 2 proce- ‘dure (laparotomy and orchiopexy) after 6 months. At laparoto- ry there was no evidence of testicular atrophy in all but one testis, which was removed, and the FS stage 2 procedure was Completed in 17 testes, The other six testes are still waiting for the second stage of the procedure. The follow-up period was between 6 months to 4 years, and two.more testicular trophies were noted after FS stage 2. The results were satis- factory in 15 out of 18 testes (83%). No major complications "were seen after FS stage J, except an operatively observed tem porary arthythmia (n= t) and postoperative fever (n= 2). After FS stage 2. wound infection was identified in one case. the intersex group, the patient with testicular feminization under- ‘went a laparoscopic orchiectomy. The other patient with bilat- eral nonpalpable testis was identified as having an uterus and. two intra-abdominally located gonads on laparoscopy and g¢ nadal biopsies were obtained for diagnosis. Histology demon- strated bilateral ovotestes, confirming the diagnosis of a true hermaphrodite, There were no technical failures or laparo- scopie complications among all the patients. The procedures and complications are summarised in Figure 1 and Table 2 Discussion ‘Although numerous strategies exist for the diagnosis and treatment of boys with NPY, controversy remains concerning the most effective. None of the imaging techniques (ulraso- ography, computerised tomography, magnetic resonance imaging, etc.) have proven ta be 100% reliable in predicting the presence or absence of testis (15). Therefore laparoscopy has gained wide acceptance asa diagnostic procedure foriden- ‘fying the exact anatomy of the testis, its adnexae and para testicular abnormalities (18). We noted the same advantages {nour examinations and thus laparoscopy has become the pri- mary diagnostic and treatment modality in the management of nonpalpable testis in our department, ‘Numerous surgical procedures have been developed for the treatment of patients with NPT. Among these ae open surgical one-stage F5, surgically ewo-staged FS, laparoscopic FS proce- ‘Table 1 Groups of testes according taleparoscopc findings 2 26 % 4 85FETE} cur] Peciatr Surg 2001; 11 Group) + Avvophictesticlatisuc removed laparosopically Acropive testelas tne rertoy $f019| meson 13 exes) Le Laparoscopic orcniopeny (testes) ephens ——» FowlerStepiens Orn, Sage Ss (testes Group esc emianonapurncope godt | oe Bese oa Fig.1 Procedures performed accarding to the laparoscopic findings, "Gro 1: Vanishing estes agenesis Goup?ow abomi testes(2em to {he inguinal rng Croup 3: gh sbdomina ests (> em fo fe inguin ing) Group 4: mtersex puters **Lapstetomy was performed on 1 ests bt one a them was emoved with ‘out compltng the FS stage 2 orcs due to tony, ure, low spermatic vessel ligation and testicular autotrans- Plantation. in Docimo's review of 64 articles pertaining to 8425 undescended testes, the success rates were reported as {67% for surgical one-stage FS, 77% for surgically staged FS pro- cedure and 84% for microvascular transfer (8). On the other hhand, Harrison et al demonstrated that one can perform mi- rovascular testicular autotransplantation in children with a success rate of 100% (13), but this technique requizes the ex- prise of the microvascular surgeon and long-term hospital- ‘sation (3,13). Another treatment technique for the high unce- scended testes by low spermatic vessel ligation was described by Koffetal, witha success rate of97% at I month and 93% at 1 year (17). The two-stage FS procedure of laparoseopically lip bing the spermatic vessels as the first stage and performing ‘pen orchiapexy around 6 months after the first stage was fist reported by Bloom, with results comparable tothe two-staged surgical FS procedure (2).In our series we had 22 patients with ‘Table2 Complications ebserved according tothe groups Topurlu Tekant G eal 26 testes (Group 2) who had low abdominal testes, less than, 2cm away from the internal ring. 19 ofthese testes were treat- ed by laparoscopy-assisted orchiopexy and 7 of them were treated by laparoscopic orchiopexy. We observed a decrease inthe diameter of two testes among the seven testes on which 2 laparoscopic orchiopexy was performed, due to injury to the testicular vessels during our learning curve, There were 20 pa ‘ients with 26 testes (Group 3) who had high abdornina testes ‘more than 2em away from the internal ring, All of these pa- tients had FS stage 1, and 14 patients (18 testes) of them had laparotomy performed for FS stage 2 procedure 6 months later. Of these testes we removed one testis due ro resticular atrophy. (observed at laparotomy. We completed FS stage 2 procedure in 1 testes; 2 testicular atrophies were observed during the fal- low-up, with an overall success rate of 83% (19}-The advantage of laparascopic clip ligation ofthe testicular artery is that itoc- cludes the internal spermatic leash with virtually no other dis turbance ofthe gonad and its vasal arcade (2). Intra-abdominal testes are reported to be developmentally ab- ‘pormal with tubular atrophy, developmental arrest and poten- tial for malignancy (3,5.13) For these reasons, Hinman recom mended removal of abdominal testicles in 1980 (14). Laparos- copy can certainly be used when orchiectomy is deemed nec essary (20). The traditional method of orchiectomy is through 2 lower abdominal incision, but if laparoscopy is already per- formed for diagnosis, placing one ar twa additional working channels and performing laparoscopic orchiectomy is a less ‘morbid alternative to open surgery. {nour series, 32 vanishing testes that were removed were re= Ported to have only fibrous tissue with no germ cells. These findings bring up the question of the need to remove this tis- sue as a routine procedure. We used laparoscopy for gonadectomy in intersex patients successfully without any complications, In conclusion, we are of the opinion that laparoscopy de- creases the number of laparotomies in NPT, allows a single- stage procedure in low abdominal testis and facilitates artery ligation in high abdominal testis. Laparoscopy also provides diagnostic and therapeutic options for vanishing testis and in- tersex patients. Croup" Complication Number of patients Group 1 (32 testes) ni 0 Group 2 (26 testes) decrease in testicular diameter postoperatively 2 Group (after FS stage!) (24 testes) temporary anhythmia 1 , fever tester atrophy 7 Group 3 [ater FS stage) (17 testes)** wound infection 1 . testicular atrophy 2 Group 4 (6 testes) + al o “Group 1: Varhirg estes genes, Grou 2 ow abdoinaltestes (2m tothe nga gh ou 3 High sbdoina testes (> 2em tothe nga gop & ne sex patents "* lepaotomy was performed on 18 testes but on ofthe mas remeved witht completing the FS tage procedure due to steph.Experience with Laparoscopy in Nonpalpable Testis References " aula, Stone 8. Laparoscopy fr ev Urology 1992: 40: 256 Bloom DA Two step orchiopexy with peluscopic clip ligation of the spermaci vessels. Ure! 1991: 145: 1030-1033, Boddy SA, Gordon AC. Thomas OFM, Browning FSC. 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Urol 1896; 156: 799 803, discussion 803 Scott JES, Laparascany a8 an aid in the diagnosis and manage- ‘ment ofthe impalpable tests} Pediatr Surg 1962; 17:14 ‘Syl, EmirH,Tekanc G, SarimuratN, BuyukunalC. Danismend I Experience with laparoscopy in nonpalpabe tests. Sth Ann- al meeting of the European Society of Pediatric Urology 1988, [April 16- 18, Salzburg, Austria 2» Thomas MD, Mercer LC, Saestein EC. Laparoscopic orchiectomy for unilateral intraabdorinal testis. Urol 1992: 148: 1251 ‘Waldschmiat J, Scher F, Surgical correction of abdominal tests after Fowier Stephens using the neodymium: YAG laser for pre- liminary vessel dissection. Eur] Pediatr Surg 1981; 1:54 Prof. Dr. Yunus Saylet Balipaga cad, Saray apc No: 85/10 ath 34250" Istanbul > Turkey E-mail: ysoylet@superoniine.com Segue nd tar aypon— piss cot cota ‘aor mane roe ‘Sunt aura European Chance of Survival: Journal af Pi iaic Surgery Good! 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