V7-13: Robotic assisted laparoscopic orchiopexy: preliminary results of an initial case series
VideoIntroductions and Objectives
The gold standard in the management of intra-abdominal undescended testicles (UDT) is laparoscopic orchiopexy, either primary or staged Fowler-Stephens (FS) laparoscopic orchiopexy. Outcomes are excellent with a reported success rates around 96% for primary laparoscopic orchiopexy. However a large number of cases, especially older children, will end up with FS orchiopexy, either one or two stages with less favorable outcomes (88% and 78% respectively) and multiple procedures in the case of two stages. We report the results of all robotic assisted laparoscopic orchiopexies performed at our institution. (1,2)
We retrospectively reviewed all robotic orchiopexy between May 2013 and October 2014. Our technique was similar to previously described laparoscopic orchiopexy, either primary, one or two stage FS.
11 procedures (6 left, 5 right) on 10 consecutive patients, age 21 months and older underwent robotic orchiopexy in our institution. A total of 5 primary orchiopexies (4 patients), 2 one-stage FS orchiopexies (2 patients) and 4 second-stage FS orchiopexies (4 patients) were performed. Mean age of the patients was 62.2±45.6 months (median 47.5). Mean operative time (cut to close) was 121.6±26.1 minutes. There were no intra-operative or post-operative complications observed, all patient were discharged home on the same day of surgery. The average follow up time was 6.2 weeks (range 1-9) with 100% of testicles viable and palpable low within the scrotum on follow up.
We report our preliminary series of Robotic assisted laparoscopic orchiopexy with very promising results. The early positive results, irrespective of the technique used, of our case series indicates that this approach may enable us to perform more intra abdominal UDT in one procedure (Primary vs One stage FS) and possibly improve the outcomes of two-stages FS orchiopexies. We believe that with better visualization of testicular vessels due to HD and 3D technology camera, utilization of Firefly fluorescence angiography with IC Green, increased magnification, and improved instrument articulation will lead to more precise dissection and preservation of testicular vasculature resulting in improved outcomes.