Safety and Efficiency of Laparoscopic Management of Intra-canalicular (Emergent) Testis
Safety and Efficiency of Laparoscopic Management of Intra-canalicular (Emergent) Testis
Undescended testes (UDTs) are a relatively common finding in pediatrics with prevalence about
 1-2% in newborns. Upon discovering a non-intrascrotal testis, it is important to determine
 whether the testis is palpable or non-palpable (1). A canalicular or 'emergent' testis may be
 impalpable initially and may be appear when it is 'milked' out of the inguinal canal (where
 it is concealed from detection) indicating that 15 to 40% of cryptorchidism are viable
 peeping/canalicular testis.

 The laparoscopic approach for treating canalicular undescended testes offers many advantages
 over open inguinal orchiopexy. The laparoscopic technique maintains the integrity of the
 inguinal canal anatomy and eliminating the need to divide the epigastric vessels during
 dissection. The ability to dissect the testicular vessels at a higher extent would increase
 the vessel length available to lower the testis without strain.

 -  This is a prospective study will be conducted at Department of Pediatric Surgery, MCH
 hospital, Bisha, Saudia Arabia and Pediatric surgery Department , Al-Azhar University
 hospitals, Cairo, Egypt, from January 2019 to October 2020 to evaluate the safety and
 efficiency of laparoscopic orchiopexy of intracanalicular testis.

 -  Patients' age and laterality will be reported. Evaluation will be done for the operative
 difficulties, intraoperative complications, operative time and early postoperative
 complications.

 Testicular site, size and vascularity will be evaluated by ultrasonography at 6th month post
 operatively. Also, cosmetic results will be evaluated by obtaining the parent's questioners
 at post-operative OPD clinic visits.

 - Laparoscopic orchiopexy for management of inguinal canalicular undescended testes is a
 safe, effective, and less invasive, without disturbance of inguinal canal anatomy, with
 better cosmetic results.
Aim of the study:

 Herein, the study aims to evaluate the laparoscopic procedure for management of canalicular
 testis regarding operative safety, efficacy and post-operative outcomes.

 Brief review of literature:

 -  Different management modalities for intra-canalicular (emergent) testes in male children
 (open surgery, Laparoscopy).

 -  Advantages of laparoscopic orchiopexy for intra-canalicular (emergent) testes.

 Patients and Methods:

 This is a prospective study, will be conducted out at pediatric surgery tertiary centers
 (Maternity & Children's Hospital in Bisha, KSA and Al-Azhar University hospitals in Cairo,
 Egypt) on pediatric patients presenting at the pediatric surgery OPD clinic by
 intra-canalicular (emergent/peeping) testes in the period from January 2019 to October 2020.
 Enrolled patients will be managed by laparoscopic orchiopexy. All patients enrolled in the
 study will give a written informed consent. The study will be approved by the Institutional
 Review Board and ethics committee of the hospitals. The main objective is to assess safety
 and efficacy of laparoscopic orchiopexy for intra-canalicular (emergent/peeping) testes in
 male patients.

 Institutes of the study:

 A multicenter study at Pediatric Surgery Departments, Maternity & Children's hospital in
 Bisha, KSA and Al-Azhar University hospitals in Cairo.

 Number of cases: Sixty two male children. Time frame: period of 1.10 years.

 Ethical Consideration:

 The protocol will be discussed and approved for clinical study by the Ethical Research
 Committee at MCH at Bisha, KSA, and other participating hospitals. The procedures and the aim
 of the study will be clearly explained to the patient and the family. A written informed
 consent will be obtained before enrollment of the patients into the study. The family refusal
 to give consent for laparoscopic management is respected but does not deprive the patient
 from getting open orchiopexy.

 Preoperative preparation:

 Proper examination done for patients using flat and frog leg position with gentile squeezing
 of testis down, proved by preoperative inguinoscrotal ultrasonography.

 Follow-up:

 Patients will be reviewed at the OPD clinic. Patients who could not attend the clinic will be
 contacted by phone. Postoperative Doppler ultrasonography will be done to assess testicular
 size and vascularity. Questionnaire will be obtained from the parents to assess their
 cosmetic satisfaction.

 Statistical analysis:

 It will be performed with IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM
 Corp. Data will be presented as mean, standard deviation, number & percentage, using
 Chi-squared test (X2) for qualitative data. The significance level will be set at P > 0.05.

 - Discussion will focus on laparoscopic management of intra-canalicular (emergent) testes.
 The results obtained from this study will be compared with each other and with that reported
 in the literature. The discussion will focus on operative details, operative time, results, &
 complications.

 It will compare results of this study with the results of others. Discussion will determine
 the most accurate management modality for intra-canalicular (emergent) testes in male
 children which offers the best outcome and least morbidity.
Inclusion Criteria:

 -  All children diagnosed as intra-canalicular (emergent/ peeping) testes

 Exclusion Criteria:

 -  Patients above 14 years of age,

 -  with retractile testes,

 -  with retractile testes that were distal to the external ring and

 -  with nonpalpable testes