Journal of pediatric surgery · 2026
Transscrotal-assisted laparoscopic orchiopexy for high palpable undescended testes with a standardized Active Tension-Reduction protocol: A retrospective single-center experience of 336 testes.
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Zhang Lei, He Hongjia, Gui Meng, He Qingbao, Wang Hao, Zhang Lingling, Hou Wenchao, Li Kaisheng
Аннотация
INTRODUCTION: The looping vas deferens, reported in 2-20% of orchiopexy series [5,6], may be at risk of inadvertent injury during conventional intra-abdominal gubernaculum division. We describe a standardized four-step Active Tension-Reduction (ATR) protocol that relocates gubernaculum division from the abdominal cavity to the scrotal incision under direct vision.
OBJECTIVE: To describe the ATR protocol and report surgical outcomes in a single-center series.
METHODS: A retrospective review of 336 high palpable (peeping and canalicular) undescended testes (281 patients) who underwent transscrotal laparoscopic orchiopexy using the ATR protocol between January 2021 and December 2024. The four-step protocol comprises laparoscopic high dissection, transscrotal gubernaculum division under direct vision, routine spermatic-cord fascial release, and selective laparoscopic release of residual fibers. Testicular position, ultrasonographic volume, and complications were assessed; reporting followed STROBE.
RESULTS: Median age was 20.0 months (IQR, 12.0-60.0). Among the 275 testes with a documented outcome, no positional failure was observed (all in satisfactory scrotal position); 61 testes (18.2%) lacked a documented outcome. A worst-case analysis counting all 61 as failures gave 81.8% (275/336; 95% CI, 77.4-85.6). There were no conversions to open surgery and no vas or vascular injury. Post-operative testicular volume increased from 0.264 to 0.334 mL (p < 0.001); absent an age-matched control, this before-after change cannot be attributed to surgery.
CONCLUSION: The ATR protocol is a feasible, reproducible approach to transscrotal laparoscopic orchiopexy with favorable short-term positional outcomes. Its theoretical advantage in protecting the looping vas deferens needs prospective validation in studies that record the looping-vas incidence.
TYPE OF STUDY: Treatment Study (Retrospective Cohort) LEVEL OF EVIDENCE: III.
OBJECTIVE: To describe the ATR protocol and report surgical outcomes in a single-center series.
METHODS: A retrospective review of 336 high palpable (peeping and canalicular) undescended testes (281 patients) who underwent transscrotal laparoscopic orchiopexy using the ATR protocol between January 2021 and December 2024. The four-step protocol comprises laparoscopic high dissection, transscrotal gubernaculum division under direct vision, routine spermatic-cord fascial release, and selective laparoscopic release of residual fibers. Testicular position, ultrasonographic volume, and complications were assessed; reporting followed STROBE.
RESULTS: Median age was 20.0 months (IQR, 12.0-60.0). Among the 275 testes with a documented outcome, no positional failure was observed (all in satisfactory scrotal position); 61 testes (18.2%) lacked a documented outcome. A worst-case analysis counting all 61 as failures gave 81.8% (275/336; 95% CI, 77.4-85.6). There were no conversions to open surgery and no vas or vascular injury. Post-operative testicular volume increased from 0.264 to 0.334 mL (p < 0.001); absent an age-matched control, this before-after change cannot be attributed to surgery.
CONCLUSION: The ATR protocol is a feasible, reproducible approach to transscrotal laparoscopic orchiopexy with favorable short-term positional outcomes. Its theoretical advantage in protecting the looping vas deferens needs prospective validation in studies that record the looping-vas incidence.
TYPE OF STUDY: Treatment Study (Retrospective Cohort) LEVEL OF EVIDENCE: III.