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Friday 29th July, 2022

Laparoscopic Cryptorchid Surgery

A cryptorchid (or ‘retained’) testicle can be a worrying prospect surgically, especially if the exact location of the gland cannot be found. 

The testicle, if not scrotally-located, will be either in the inguinal region, abdominal, or very rarely stuck between the two, in the inguinal ring. 

Inguinal testicles

These can be difficult to palpate in the conscious animal, some of them only revealing themselves when under anaesthesia.

We’ve possibly all heard of the stories, witnesses or been the one doing the surgery, where you just cannot find it. 

The dog may end up with a scrotal incision, two inguinal ones and a midline para-penile incision before it has been found. 

Our surgeons have even performed second surgeries laparoscopically where, after failed first surgery lasting two hours, with three vets scrubbed in, and all of the incisions listed above the testicle still was not found. 

The para-penile incision necessitates dissecting through muscle which leaves significant pain, bruising and extended healing times. The laparoscopic approach makes all of these difficulties disappear. 

The laparoscopic approach

Using a single midline 5mm incision for the laparoscope port just caudal to the umbilicus the testicle is usually locatable within 30 seconds. 

The dog is tilted to the appropriate side by 30 degrees or so to facilitate movement of the intestines away from the testicle. A stab incision through the skin and abdominal muscles is made above the testicle. Long tipped artery forceps are passed into this hole and the testicle is grasped under visual guidance. 

The incision is made only large enough to extract the testicle at the end of the forceps and removed externally in a normal fashion. 

An alternative is to place a second port and dissect the testicle internally with vessel sealing equipment, but this actually increases the number and sizes of the wounds and generally takes longer. 

The solution for inguinal laparoscopically

If a laparoscopic approach has been made when the testicle was in fact inguinal or in the inguinal ring then there are minimally invasive options available too. By placing a second 5mm port, grasping Babcock forceps can be passed in to locate and manipulate the vas deferens. 

Gentle traction can retrieve a testicle from the inguinal ring. Simple manipulation will readily reveal the location of the inguinal testicle by its movement. 

The operation in action

Watch the video to see how quickly these can be located.

Posted by Rhea Alton