| Objective: To explore the safety,feasibility and efficacy of different access laparoscopiclly assisted orchiopexy by compairing the outcomes and perioperative complications of single-port laparoscopically assisted transcrotal orchiopexy,transumbilical single-site 3-port laparscopic orchiopexy and conventional 3-port laparscopic orchiopexy for children with intracanalicular cryptorchidism.This study aimed to provide ideal clinical evidences for the option of laparoscopic orchiopexy in children with intracanalicular testes.Methods: Between January 2014 and December 2016,a total of 270 cases with undenscended testes in inguingal canal were treated by three different access laparoscopically assisted approaches including 111 cases with conventional 3-port laparscopic orchiopexy(3-port group),84 cases with transumbilical single-site 3-port laparscopic orchiopexy(single-site group),and 75 cases with single-port laparoscopically assisted transcrotal orchiopexy(single-port group).The data of operating time,pneumoperitoneal time,estimated blood loss,peristalsis revival time,postoperative stay period,perioperative morbidities(including accidental injuries,hypercapnia,incisional pain,incisional infection,scrotal hematoma or edema),and longterm complications(including testicular atrophy,retration and malignancies)were retrospectively reviewed and compaired in three groups.The data were statistically processed by SPSS21.0,and the differences were considered as statistical significance(P<0.05).The age,operating time,blood loss and hospitalization time were analyzed by Mann-Whitney U test,while the data of complications among groups were conducted by chi-square test or Fisher's exact test.Results: All of children with intracanalicular cryptorchidism were completed successfully by laparoscopically assisted orchiopexy.No intraoperative complications and conversions were found.1 The operating time(OT)1.1 OT of unilateral cryptorchidism : OT of single-port group(46.12 ± 5.52min)was significantly shorter than 3-port group(59.71±8.32 min)(P<0.01),and OT of 3-port group was shorter than single-site group(67.30±8.02 min)(P<0.01).1.2 OT of bilateral cryptorchidism : Compared with 3-port group(77.39 ±6.19min)and single-site group(85.00 ± 3.40min),OT of single-port group(61.25±5.28min)was significantly shorter(P<0.01),and OT of 3-port group was shorter than single-site group(P<0.01)?1.3 OT of unilateral cryptorchidism combined with patent processus vaginalis(PPV): Compared with 3-port group(68.23 ± 7.06 min)and singlesite group(75.71±7.88min),OT of single-port group(51.29±5.27min)was significantly shorter(P<0.01),while no differences ware found between 3-port group and single-site group.2 The pneumoperitoneal time(PT)2.1 PT of unilateral cryptorchidism : PT of single-port group(12.63 ± 1.66min)was significantly shorter than 3-port group(27.36±4.96 min)and PT of3-port group was shorter than single-site group(31.63±7.87 min)(P<0.01).2.2 PT of bilateral cryptorchidism: Compared with 3-port group(39.78 ±5.10min)and single-site group(50.00 ± 3.40min),PT of single-port group(19.00±1.05min)was significantly shorter(P<0.01),and PT of 3-port group was shorter than single-site group(P<0.01).2.3 PT of unilateral cryptorchidism with PPV: Compared with 3-port group(35.00 ±4.08min)and single-site group(42.14 ±3.94min),PT of single-port group(16.71±1.38min)was significantly shorter(P<0.01),and no difference was found between 3-port group and single-site group.3 The estimated blood loss(EBL)3.1 EBL of unilateral cryptorchidism:EBL of single-port group(1.41±0.50ml)was significantly less than 3-port group(3.35±1.30 ml),and EBL of 3-port group was less than single-site group(4.57±1.42 ml)significantly(P<0.01).3.2 EBL of bilateral cryptorchidism: EBL of single-port group(2.25±0.46ml)was significantly less than 3-port group(4.82 ± 1.20ml),and EBL of 3-port group was significantly less than single-site group(6.14±1.51ml)(P<0.01).4 The peristalsis revival time: All of children were obeyed the rule of Fast Track Surgery to drink water after surgery in six to twelve hours.If no nausea,vomiting,or abdominal distension were observed,the patients can take food gradually.Because they recovered successfully with no discomfort and no significant difference,there was no need to conduct statistical comparison.5 The postoperative stay(PS): The average PS were 4.27 ± 1.70 d in 3-port group,4.10 ± 1.49 d in single-site group and 4.12+1.09 d in single-port group respectively.There were no differences among them(P>0.05).6 Perioperative complications: There were 2 cases with incisional pain in 3-port group,accounting for 1.80%.In single-site group,seven cases with incisional pain and one case with hypercapnia were found,accounting for9.52%.Meanwhile,one case with scrotum hematoma was found in single-port group(1.33%).It showed higher rates of incisional pain in single-site group than 3-port and single-port group.7 Long-term outcomes: In postoperative follow-up,no testicular atrophy,malignancies and inguinal hernia or hydrocele formation were observed.There were 2 cases with retraction of testicular in 3-port group,accounting for 1.80%.In single-site group,one case with testicular retraction was found,accounting for 1.20%.There was also one case with testicular retraction in the 3-port group.No differences among these three groups were found in terms of longterm complications.Conclusions: For the advantages of less complications and high successful rates,laparoscopically assisted orchiopexy for intracanalicular cryptorchidism has its feasibility and safety.Transumbilical single-site 3-port laparoscopic orchiopexy is more laborious and time-consuming for the collision of instruments and has no advantages of minimal invasive surgery.With less operating time,less blood loss and better cosmetic effect,single-port laparoscopy combined transcrotal approch orchiopexy can be the optimal access for intracanalicular cryptorchidism. |
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