Login to Access Video or Poster Abstract: MP66-12
Sources of Funding: None

Introduction

Conventional laparoscopy is routinely used for the evaluation and management of the non-palpable testis but routinely requires three 5 mm ports that result in 9-10 mm scars. We have developed novel percutaneous externally assembled laparoscopic (PEAL) instruments which allow for nearly scarless laparoscopy. We present here a clinical series of six pediatric patients who underwent a Fowler-Stephens orchiopexy using these instruments.

Methods

Using the PEAL instruments, one patient underwent a single stage, four patients underwent a first stage and one patient underwent a second stage Fowler-Stephens orchiopexy. In all cases, a 5 mm port was placed at the umbilicus for the camera. The PEAL instrument, which consists of a reusable handle and a 2.96 mm shaft was then introduced lateral to the rectus sheath at the level of the umbilicus using a special introducer tip under direct visualization. The introducer was then brought out through the camera port and switched to a 5 mm grasper tip. An additional 5 mm port was placed on the right at the same level for insertion of a hook electrode and clip applier.

Results

The PEAL instruments functioned well for all dissection and grasping tasks, similar to 5 mm conventional instruments. Using these innovative new instruments, all patients underwent successful Fowler-Stephens procedures. Median operative time was 66 minutes (45-180 minutes). Blood loss was less then 5 mL in all cases. All six patients were discharged the day of surgery. The procedures were well tolerated without any perioperative or postoperative complications. At follow up, the average length of the PEAL scars was 3.25 mm, while the 5 mm port scars were 10 mm.

Conclusions

We describe a novel instrument paradigm for performing a pediatric laparoscopic Fowler-Stephens orchiopexy. These instruments offer improved cosmesis compared to conventional laparoscopy, and may show promise in other laparoscopic applications.

Funding

None