Laparoscopic orchidopexy: one-stage alternative for non-palpable testes.

Laparoscopy was utilised in the evaluation of 24 non-palpable undescended testes in 19 children. The procedure was accurate in all patients while ultrasound (US) and magnetic resonance imaging (MRI) failed to localise the testes in most cases. At the same time laparoscopic orchidopexy was performed on 15 testes (62.5%). The remaining testes were either absent or atrophic, in which case they were excised. There were no complications from these procedures and the hospital stay was short. Paediatric laparoscopy is safe and effective in the definitive management of non-palpable undescended testes.

Laparoscopic ligation of varicoceles: an anatomically superior operation.

Since December 1991, 25 consecutive symptomatic male patients with 26 varicoceles were treated by laparoscopic ligation of internal spermatic veins under general anaesthesia. Twenty-one patients had either scrotal discomfort or painful swelling and four patients presented with infertility. The mean follow-up period is 5 months (range 3 weeks to 9 months). The procedure has provided a satisfactory outcome in 19 out of 21 patients (90.5%) with scrotal symptoms. Of the four patients presenting with infertility due to oligospermia, three had significantly elevated sperm counts at 3 months which resulted in one pregnancy. So far there has been no recurrence of the varicocele. The main potential advantage of the laparoscopic approach is better visualisation of the anatomy, especially the testicular artery and the collateral venous circulation at the level of the internal inguinal ring. In addition to being less invasive with implied benefits, the endoscopic procedure has enabled identification of multiple veins in 22 out of 26 (84.6%) varicoceles in our series.

Laparoscopic colectomy. Where do we stand?

Laparoscopy has changed our approach to surgery, instrumentation and training. The techniques are evolving for a wide range of surgical procedures outside the biliary tree. Currently available data suggests that laparoscopic colectomy can be completed safely in most cases. It is feasible and offers patient-related benefits similar to those described for other laparoscopic procedures. The advisability of performing laparoscopy for cure of colorectal malignancy has been challenged because the recurrence rates and overall cure rates remain unknown. Until prospective randomized trials resolve these issues neoplastic colon laparoscopic surgery must be the prerogative of selected and specialized centers.