Robotic Orchidopexy for Intra-abdominal Testes
摘要
Undescended testes remain a common consult in the pediatric urology clinical setting. In particular, the nonpalpable testis provides a surgical challenge. First, this situation requires determining the position of the testis if it is present. Diagnostic laparoscopy remains the gold standard for identifying the presence and location of a nonpalpable testis. Traditionally, laparoscopic orchiopexy has been performed in the same setting if a viable testis is present within the abdomen (Kolon et al., J Urol 192(2):337–45, 2014). As with other surgeries involving delicate structures, the traditional laparoscopic approach to orchiopexy is technically challenging. Today, with a shift in case volume from traditional laparoscopy toward robot-assisted laparoscopic surgery, younger surgeons are increasingly less experienced with traditional laparoscopy, and inversely more comfortable with the da Vinci® (Intuitive Surgical, Inc., Sunnyvale, CA) platform in urology, and even pediatric surgery (Denning et al., Surg Clin North Am 100(2):431–43, 2020, Mattioli et al., J Laparoendosc Adv Surg Tech A 27(5):539–45, 2017, Shah et al., Transl Androl Urol 10(5):2151–7, 2021). However, the integration of robotics into urology residency programs is not yet formalized (Hague and Merrill, Curr Urol Rep 22(9):47, 2021). At our center, we have begun to consider a robotic approach for any surgery traditionally approached with laparoscopy. Preoperatively, we discuss the potential use of the robot (if an intra-abdominal testis is noted intraoperatively) with the family. We quote similar risks as with laparoscopic surgery, including the potential for injury to surrounding structures, and potential need for conversion to an open approach.