Laparoscopy: cryptorchidectomy in Cats (Felis) | Vetlexicon
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Laparoscopy: cryptorchidectomy

ISSN 2398-2950

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Synonym(s): Key-hole cryptorchidectomy, Laparoscopic cryptorchidectomy

Introduction

  • Cryptochidism is the failure of one or both testicles to descend down into the scrotum. The retained testicle(s) can be inguinal, pre-scrotal or abdominal. Incidence in dogs between 1.2-12.9% and cats 1.3-3.8%. Monorchidism and anorchism are rare.
  • Abdominally retained testicles are up to 13.6 times more likely to develop testicular neoplasia and at higher risk of developing torsion than a descended testicle.
  • Removal of the non-distended abdominal testicle can be performed via open or minimal invasive (laparoscopic) surgery.
  • The patient should always be fully castrated or as a minimum a vasectomy should be performed on the remaining testicle. This can be done laparoscopically using a vessel sealing device.

Uses

  • Minimal invasive abdominally retained testes removal.

Advantages

  • Rapid recover.
  • Improved visualization and magnification.
  • Reduces risk of urethral avulsion (and accidental prostatectomy).

Disadvantages

Technical problems

  • Increased intra-abdominal pressures can cause cardiovascular and respiratory changes.
  • Emphysema.
  • Splenic laceration.
  • Hemorrhage.
  • Incisional hernia.

Alternative techniques

Time required

Preparation

  • 15-30 min.

Procedure

  • 15-30 min.

Decision taking

Criteria for choosing test

Requirements

Personnel

Veterinarian expertise

  • Advanced.

Anesthetist expertise

  • Standard - trained for laparoscopic procedures.

Nursing expertise

  • Standard.

Materials required

Minimum equipment

  • Light source.
  • Light guide cable.
  • Camera unit.
  • Camera head.
  • Monitor.
  • Archiving system.
  • Insufflator.
  • CO2.
  • Minimum of two 6 mm cannulas (threaded).
  • Endoscope:
    • Rigid 5 mm 0˚ or 30˚.
  • Palpation probe.
  • Vessel sealing devices, eg ENSEAL, Ligasure, Harmonic ACE. This is not really necessary for single sided cryptorchids as the testicle can be exteriorized and ligated extracorporeally. It is useful in bilateral cryptorchids to dissect the contralateral testicle, but these are relatively rare.
  • Endoscopic: Babcock forceps, palpation probe.
  • Optional: Tilting table, Veress needle, fan retractor.

Minimum consumables

  • Drapes.
  • Swabs.
  • Stay suture (not necessary if not using vessel sealing device).
  • Suture to close the portal incisions.

Preparation

Site preparation

  • Clip ventral abdomen.
  • Aseptic skin prep Surgery: asepsis.
  • Bladder expression.

Restraint

Technique

Approach

Step 1 - Positioning

  • Dorsal recumbency. Can use 25-30° of of trendelenburg and rotate the patient 30-45° to the contralateral side to aid exposure and visualization of the testicle.
  • Endoscope tower placed at the caudal end of the table, for bilateral cases. For unilateral cases the tower can be placed on the ipsilateral side of the table to the side of the testicle, the surgeon on the contralateral side.

Step 2 - Approach for a two-portal technique

  • A 1 cm incision is made 1 cm caudal to the umbilicus.
  • The subcutaneous tissue is dissected bluntly directly down onto the linea alba.
  • The linea alba is grabbed with a pair of thumb forceps and tented.
  • Stay sutures are placed at the cranial and caudal aspect of the mini-approach.
  • A stab incision is made through the linea alba and peritoneum.
  • The cannula is placed, and the abdomen inflated to 4-6 mmHg capnoperitoneum.A Veress needle can be used for abdominal insufflation as an alternative. This requires a much smaller incision and is generally simpler to perform.
  • The endoscope is inserted.
  • Under direct visualization with the endoscope the second portal is placed on the midline just cranial to the prepuce or in a caudal paramedian position on the ipsilateral side to the cryptorchid testicle.It is often easiest to visualize the testicle before placing the second port. The port can then be positioned directly over the cryptorchid testicle, facilitating its removal from the abdomen

Core procedure

Step 1 - Localization 

  • Visualize the inguinal canal.
  • If only the gubernaculum can be seen entering the inguinal canal the testicle can be found by following the gubernaculum cranially.
  • If the ductus deferens and pampiniform plexus can be seen entering the inguinal canal the testicle has completed its abdominal decent. In some cases the testicle can be retracted back into the abdomen if it is still within the inguinal canal. Grab the ductus deferens with a pair of atraumatic Babcock forceps and apply gentle traction.

Step 2 - Ligation

  • The testicle is lifted up to the abdominal wall with an atraumatic Babcock forceps or palpation probe.
  • A percutaneous stay suture is placed through the testicle. An Endograb device may be used instead.
  • Ligation can be achieved with a vessel sealing device, eg ENSEAL. In unilateral cases, if the port is placed over the testicle, it can be grasped with Babcocks and simply exteriorized through the abdominal wall with the cannula, allowing the vas deferens and pampiniform plexus to be ligated as normal. This obviates the need for a vessel sealing device (which are expensive to buy and sterilize) and is quicker as there is no need to fix the testicle to the abdominal wall, etc.
    • If bilateral the same procedure is performed on the contralateral side.

Exit

Step 1 - Extraction

  • Grab the testicle with the Babcock forceps. If the testicle is too large to fit through the cannula the incision can be extended slightly.
  • The portal is re-inserted or occluded otherwise and the abdomen checked for bleeding prior to deflating the abdomen.
  • Turn off the insufflation and deflate the abdomen.

Step 2 - Closure

  • Close in three layers:
    • Linea alba, subcutaneous and intradermal layers (or if paramedian, muscularis layers, subcutis and intradermal layers).

Aftercare

Immediate Aftercare

Monitoring

  •  As with routine abdominal procedures. 

General care

  • Elizabethan collar.
  • No swimming for the first 14 days.
  • Rest in a single room for the first day. Can return to usual exercise the following day.

Analgesia

  • NSAIDs.
  • Opioids.

Wound Protection

  • Primapore.

Potential complications

  • Standard surgical complications:
    • Infection, seroma Seroma, dehiscence.
  • Subcutaneous emphysema.

Long term Aftercare

Follow up

Outcomes

Complications

  • Splenic laceration.
  • Hemorrhage.
  • Incisional hernia.
  • Wound dehiscence.

Reasons for treatment failure

  • Not identifying the testicle.

Prognosis

  • Excellent.

Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Hayes H M Jr, Pedergrass T W (1976) Canine testicular tumors: epidemiologic features of 410 dogs. Intl J Canc 18 (4), 482-487 PubMed.
  • Pearson H, Kelly D F (1975) Testicular torsion in the dog: a review of 13 cases. Vet Rec 97(11), 200-204 PubMed.

Other Sources Of Information

  • Lhermette P, Sobel D & Robertson E (2020) BSAVA Manual of Endoscopy and Endosurgery in the Dog and Cat. 2 edn. BSAVA Publications, Print book ISBN 978-1-910443-60-6  e-Book ISBN 978-1-910443-62-0.
  • Fransson B & Mayhew P (2015) Small Animal Laparoscopy and Thoracoscopy. 1 st ed. ACVS Foundation: Wiley Blackwell.