Evaluate The Laparoscopic Technique Biology Essay

Published:

This essay has been submitted by a student. This is not an example of the work written by our professional essay writers.

The word cryptorchidism comes from the Greek roots Kryptos hidden and Orchis testis and means absence of testis from the scrotum, which would be undescended, retractile, ectopic or absent (1).

Incidence varies with patient's age from 30% in premature neonates to 0.8% in one-year-old infants. Unilateral in 68% of cases, 70% of cases in the right side. (2)

20% of non-palpable testes are absent.

Non-palpable testes have an increased risk of malignant transformation, is highly associated with infertility and epididymal malformation (3). Many diagnostic methods have been described; the most promising is the use of laparoscopy (4).

We present our experience with laparoscopy in the evaluation of impalpable testes.

Materials and methods: -

The criteria established for laparoscopy were testicular absence detected by physical examination, ultrasound or examination under anesthesia.

Between the periods of January 2002 and September 2003, a total of 16 patients (age range from 16 to 24 with a mean age of 20 year) with 19 impalpable testes underwent laparoscopic evaluation at the hospitals of Royal Medical Services.

Data collected included patients' age, affected side, size of testes, position, operation performed and complications.

Testes not palpable at office visit but palpable at surgery were defined as being palpable testes, and were excluded from this study.

Hormonal profile was not done to our patients as it was not indicated.

Under general anesthesia, with the patient in the Trendelenburg's position, a 5mm subumbilical incision was deepened into the peritoneum and a 5mm Hasson blunt trocar was inserted. The abdomen then insufflated with Carbon Dioxide (pressure limit 16 cm H2O). The abdomen is inspected to rule out any injury, and then with particular attention to landmarks testicular location, the location of vas deferens, and the testicular vessels and the presence of a patent processus vaginalis are attempted.

Further surgical intervention was then arranged according to the findings during laparoscopy.

The procedure is started by inspection along the psoas gutter superiorly and the internal ring until we detect the spermatic vessels. In cases when the vessels or the vas were not visualized clearly this is an indication of a congenitally absent testis.

If the vessels are visualized they are followed down as far as possible to reach the terminal end which might have the atrophic or small testis. This can be achieved with the assistance of a 5-mm forceps and scissors. If the testis was found to be atrophic, orchidectomy was performed by clipping the vessels and extraction of the testes. In younger children orchidopexy is a feasible option.

Results:-

Sixteen patients (with age range from 16 to 24 years (mean age of 20 years)) underwent laparoscopy to localize 19 impalpable testes. Thirteen patients had unilateral impalpable testis while 3 patients had bilateral impalpable testis.

Thirteen testes were atrophic (68%) and 6 were absent (32%). Out of the 19 impalpable testes, 12 were in the right side (63%) and 7 on the left side (37%).

Abdominal ultrasound and CT scan were performed for all patients to confirm the clinical diagnosis, abdominal ultrasound revealed positive results in 11 testes (58%), however, abdominal Ct scan showed positive results in 16 testes (85%).

Consistency was found between clinical findings and histopathological biopsy as shown in table I.

There were no cases of renal agenesis.

Laparoscopic orchidectomy was done in all cases of atrophic testes.

Histopathological report for all extracted testes reported as that the sections contain portions of testicular tissue showing peritubular fibrosis and interstitial fibrosis. Spermatogenesis activities were not seen. There were no any pre-malignant changes. A final diagnosis of atrophic testes. (Table 1)

Table 1 Summary of Results

Pt. No.

Age (yrs)

Side

U/S

CT

Finding

Biopsy

Size

1

20

Left

Negative

Positive

Absent

Absent

N.A*

2

22

Bilat.

Positive

Positive

atrophic

atrophy

2x2x1

3

16

Right

Negative

Positive

Absent

Absent

N.A*

4

18

Right

Negative

Positive

atrophic

atrophy

1x1.5x2

5

24

Right

Positive

Negative

atrophic

atrophy

1x1x1.5

6

21

Bilat.

Negative

Positive

atrophic

atrophy

2.5x1x1

7

22

Left

Negative

Negative

atrophic

atrophy

2x1x1

8

23

Left

Positive

Positive

Absent

Absent

N.A*

9

18

Right

Positive

Negative

atrophic

atrophy

1x1x1.5

10

20

Right

Positive

Positive

atrophic

atrophy

1x2x1.5

11

19

Right

Negative

Positive

Absent

Absent

N.A*

12

21

Left

Positive

Positive

atrophic

atrophy

1x2x1

13

17

Bilat.

Positive

Positive

Absent

Absent

N.A*

14

17

Right

Positive

Positive

atrophic

atrophy

1x1x1.5

15

23

Right

Positive

Positive

atrophic

atrophy

2x1x1.5

16

23

Right

Negative

Positive

atrophic

atrophy

2x1x1.5

N.A*:- Not available

Discussion: -

Laparoscopic surgery has become popular in the surgical diagnosis and treatment of impalpable testes owing to its efficacy, minimal invasiveness and lower morbidity rate (5, 6, 7). It provides us with information about testicular location, testicular presence or absence and allows definite management (8). Laparoscopy helped a lot in the management of the impalpable testes where localization can be done accurately since other modalities like ultrasound and CT scan have failed to achieve this goal especially in intra abdominal testes.

During surgery proper examination under anesthesia is so helpful to find inguinal testes which were missed on clinical physical examination. Examination under anesthesia should always be done as first step in diagnostic laparoscopy for impalpable testis (9).

Laparoscopy is helpful in diagnosis of vanishing testis and gives us precise information about its location in all cases. (8).

If the vas or vessels entering the ring are distinctly atretic this indicates that it is unlikely to find viable testis meaning a congenitally absent testis (2). However the presence of notably decreased size in comparison of normal size of the mentioned structures does not exclude the presence of viable testis (5). In addition, the presence of normal looking vas or vessels give chance of only 50% to find viable testes which can be surgically salvaged (10).

Laparoscopy help us to identify an intra abdominal vanishing testes with a lower morbidity rate in comparison with the need of an extensive open abdominal exploration (1).

Laparoscopy is safe, minimally invasive procedure with low morbidity. It enables precise diagnosis and management of impalpable testis.

In addition laparoscopic procedure has better results than open procedures with the advantage of smaller incisions, better diagnosis of the presence or absence of the testes and better localization of the testes. It has the advantage of the possibility of laparoscopic orchidectomy or orchidopexy and finally shorter postoperative recovery.

Limitation of the Study:-

Hormonal profile was not done.

Conclusion: -

Laparoscopic diagnosis and management of impalpable testes is safe, effective and minimally invasive technique with low morbidity that enables precise diagnosis of impalpable testes (4, 5, 6, 7).

Adding to this it has better cosmetic results and advantage in case of bilateral disease. It needs shorter operative time, shorter hospital stay where this procedure is done on basis of day case surgery and earlier return to normal activities (5).

Writing Services

Essay Writing
Service

Find out how the very best essay writing service can help you accomplish more and achieve higher marks today.

Assignment Writing Service

From complicated assignments to tricky tasks, our experts can tackle virtually any question thrown at them.

Dissertation Writing Service

A dissertation (also known as a thesis or research project) is probably the most important piece of work for any student! From full dissertations to individual chapters, we’re on hand to support you.

Coursework Writing Service

Our expert qualified writers can help you get your coursework right first time, every time.

Dissertation Proposal Service

The first step to completing a dissertation is to create a proposal that talks about what you wish to do. Our experts can design suitable methodologies - perfect to help you get started with a dissertation.

Report Writing
Service

Reports for any audience. Perfectly structured, professionally written, and tailored to suit your exact requirements.

Essay Skeleton Answer Service

If you’re just looking for some help to get started on an essay, our outline service provides you with a perfect essay plan.

Marking & Proofreading Service

Not sure if your work is hitting the mark? Struggling to get feedback from your lecturer? Our premium marking service was created just for you - get the feedback you deserve now.

Exam Revision
Service

Exams can be one of the most stressful experiences you’ll ever have! Revision is key, and we’re here to help. With custom created revision notes and exam answers, you’ll never feel underprepared again.