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Bipolar diathermy as another method for testicular vascular division in laparoscopic two-stage Fowler–Stephens orchidopexy: A retrospective study

Hamdan H. Alhazmi


Objective The current study assessed the outcome of the two-stage laparoscopic Fowler–Stephens orchidopexy (LFSO) for intra-abdominal testis (IAT). Testicular blood vessels were divided by two different methods, bipolar diathermy or the conventional clipping method.
Summary background data The shortness of testicular vessels may play a role in making the surgical approach in IAT a technical challenge and can hinder the  dragging of the testicles to the scrotum.
Patients and methods We reviewed 31 records of pediatric patients who underwent operations for IAT between July 2010 and July 2017, using the two-stage LFSO. We evaluated methods used for dividing the testicular vessels in the first stage. We evaluated the intrascrotal position and testicular size. Success was defined as a nonatrophic, intrascrotal testis.
Results Two-stage LFSO was performed in 31 boys with 39 IAT. The mean age at the first stage was 32.18 months and at the second stage was 42.25 months. Two  methods were used to divide the testicular vessels in the first stage of the LFSO, which were clipping by metallic clips (5 mm) in 25 testes and bipolar diathermy (3 mm) in 14 testes. With an average follow-up of 16 months, the preoperative volume was maintained in 97.43% of the testes, whereas 94.87% of the testes were intrascrotal. One testicular atrophy was reported in the clipping group. Two testicles were outside the scrotum within the bipolar coagulation group.
Conclusion Two-stage LFSO is safe and feasible. Bipolar diathermy could be used as an alternate method for dividing testicular vessels. 

Keywords: Fowler–Stephens, intra-abdominal testis, laparoscopic, laparoscopic Fowler–Stephens orchidopexy, nonpalpable testes, orchidopexy, pediatrics