Laparoscopic manoeuvre for orchidopexy in high intra-abdominal testes when cremasteric artery is present

De Carli, Claudio; Bettolli, Marcos; Leonard, Michael; Jauregui, Esteban; Guerra, Luis

doi:10.1016/j.jpurol.2009.06.003

« Previous Next »Journal of Pediatric Urology
Volume 6, Issue 1 , Pages 2-5, February 2010

Laparoscopic manoeuvre for orchidopexy in high intra-abdominal testes when cremasteric artery is present

Claudio De Carli
- Division of Pediatric Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada K1H 8L1
- Corresponding author. Tel.: 1 613 737 7600x3692; fax: 1 613 738 4271.
Marcos Bettolli
- Division of Pediatric General Surgery, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada K1H 8L1
Michael Leonard
- Division of Pediatric Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada K1H 8L1
Esteban Jauregui
- Department of Anatomy, University of Cordoba, Cordoba, Argentina, 419, Chubut St PC 5000, Argentina
Luis Guerra
- Clinical Epidemiology, University of Ottawa, CHEO, 401, Smyth Road, Ottawa, Ontario, Canada K1H 8L1

Received 5 May 2009; accepted 8 June 2009. published online 19 November 2009.

Abstract

Objective

We report a case of high intra-abdominal testes (HIT) associated with the presence of the cremasteric artery (CA). The aim was to correlate the normal anatomy of the CA with the clinical finding in our patient and discuss its surgical implication.

Methods

Left primary laparoscopic testicular descent by the Prentiss manoeuvre was performed in a 2 year-old boy with bilateral HIT. Cadaveric dissection was carried out focusing on the anatomical origin of the CA. Data obtained from cadavers and the clinical findings were analyzed.

Results

During laparoscopic orchiopexy a left HIT was found in the presence of the CA. Primary tension-free orchiopexy was achieved preserving the CA. Our cadaver study revealed that the CA arose more frequently (68%) from the medial aspect of the inferior epigastric artery.

Conclusion

In the presence of HIT, surgeons should be aware of the CA as part of the testicular collateral circulation. Acquaintance with the normal anatomy of the CA is important to determine the most appropriate laparoscopic manoeuvre in orchiopexy when this artery is present. We believe that the Prentiss manoeuvre avoids compression and strangulation of the CA around the epigastric vessels while allowing testicular placement in the scrotum.

Keywords: Laparoscopic orchiopexy, Intra-abdominal testes, Cremasteric artery