Necip PİRİNÇÇİ, İlhan GEÇİT, Mustafa GÜNEŞ, KEREM TAKEN, Serhat TANIK, Kadir CEYLAN

Çocukluk dönemi palpe edilemeyen testiste laparoskopik yaklaşım: İlk deneyimlerimiz

Amaç: Çocukluk dönemi palpe edilemeyen testisli olguların tanı ve tedavisinde laparoskopik yaklaşım değerlendirildi. Gereç ve Yöntemler: Aralık 2010-Temmuz 2011 tarihleri arasında toplam 10 hasta değerlendirildi. Tüm hastalar preoperatif olarak ayrıntılı anamnez, fizik muayene, ultrasonografi ve manyetik rezonans görüntülemeyle değerlendirildi. Dördü manyetik rezonans görüntülemeyle tespit edilen; 6’sı ise fizik muayene ve görüntüleme yöntemleriyle tespit ve palpe edilemeyen inmemiş testisli 10 olguya laparoskopik girişim uygulandı. Laparoskopik girişimler testisin varlığını belirleme, laparoskopik orşiopeksi yada laparoskopik orşiektomi şeklinde uygulandı. Hastaların genel anestezi altında skrotal muayeneleri tekrar yapıldı. Hasson yöntemiyle ilk trokar yerleştirildi. Ayrıca iki tane 5 mm trokar daha yerleştirilerek toplam 3 trokar ile işleme gerçekleştirildi.Bulgular: Yaşları 1-14 ortalama 5.5 yıl arasında değişen; toplam 10 olgunun 4’ünde sağ, 3 ‘ünde sol ve 3 olguda ise testisler bilateral olarak palpe edilemedi. Bilateral palpe edilemeyen 2 olguda, sol taraf palpe edilemeyen bir olguda ve sağ taraf palpe edilemeyen 1 olguda; manyetik rezonans görüntüleme ile testis intraabdominal olarak saptandı ve intraabdominal olarak saptanan bu olguların hepsine laparoskopik orşiopeksi uygulandı. Fizik muayene ve görüntüleme yöntemleriyle tespit edilemeyen 6 olgunun 7 inmemiş testis hepsinde testis; laparoskopide intraabdominal yerleşimli olarak saptandı. Bu olguların 2’sine laparoskopik orşiektomi uygulanırken; 4 olguya 5 inmemiş testis laparoskopik orşiopeksi uygulandı. Hiçbir olguda intraoperatif komplikasyon oluşmadı. Orşiektomi uygulanan iki olgunun histopatolojik değerlendirmesi atrofik testisle uyumluydu. Sonuç: Laparoskopi; fizik muayene ve görüntüleme yöntemleriyle tespit edilemeyen intraabdominal testislerin tanı ve tedavisinde minimal invaziv bir tedavi seçeneği olarak tercih edilmelidir

Anahtar Kelimeler:

İnmemiş testis, laparoskopi, orşiektomi, orşiopeksi

Laparoscopic approach in non-palpable testis in childhood: Our first experiences

Objective: The laparoscopic approach was evaluated in the diagnosis and treatment of the cases with non-palpable testis in childhood. Material and Methods: A total of 10 patients were evaluated between the dates of December 2010 and July 2011. All of the patients were evaluated with detailed history, physical examination, ultrasonography and magnetic resonance imaging before the surgery. Laparoscopic procedure was performed to 10 cases with non-palpable testis, four of whom could be detected with magnetic resonance imaging and six of whom could not be detected with the physical examination and the methods of the imaging. Laparoscopic procedures were performed in the form of the determination of the presence of the testis, laparoscopic orchiopexy or laparoscopic orchiectomy. Scrotal examinations of the patients were done again under general anesthesia. The first trocar was inserted with the method of Hasson. In addition, by placing two more 5 mm-trocar, the process was carried out with a total of 3 trocars.Results: Findings: The testis could not be palpated right in 4, left in 3 and bilateral in 3 of a total of 10 cases whose ages ranged from 1-14 mean 5.5 years. The testis in 2 cases who could not be bilaterally palpated, in one case whose left side was not palpated and in 1 case whose right side was not palpated was detected as intra-abdominal with the magnetic resonanmeyen 6 olgunun 7 inmemiş testis hepsinde testis; laparoskopide intraabdominal yerleşimli olarak saptandı. Bu olguların 2’sine laparoskopik orşiektomi uygulanırken; 4 olguya 5 inmemiş testis laparoskopik orşiopeksi uygulandı. Hiçbir olguda intraoperatif komplikasyon oluşmadı. Orşiektomi uygulanan iki olgunun histopatolojik değerlendirmesi atrofik testisle uyumluydu. Sonuç: Laparoskopi; fizik muayene ve görüntüleme yöntemleriyle tespit edilemeyen intraabdominal testislerin tanı ve tedavisinde minimal invaziv bir tedavi seçeneği olarak tercih edilmelidir

Keywords:

Undescended testis, laparoscopy, orchiectomy, orchiopexy,

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