Minimal-invasive Chirurgie bei Kryptorchismus und Varikozele

The use of laparoscopy is a valuable addition for diagnosis and therapy of the impalpable testis.After exclusion of intersex in the case of bilaterality diagnostic laparoscopy should be the first operative intervention.The identification of blind ending spermatic vessels and vas deferens establishes the diagnosis of abdominal vanishing testis and no further therapy is required.The finding of a regular entry of the vas and vessels in the internal inguinal ring indicates groin exploration to remove atrophic testicular tissue or germ rudiments because of their risk of malignant degeneration.At the same anesthesia intraabdominal testes may be removed or the first stage of Fowler-Stephens repair can be performed laparoscopically. In addition to that more recently one-stage laparoscopic orchidopexy has been described. The open techniques of varicocelectomy are also increasingly replaced by primary laparoscopic approach.The retroperitoneal ligation of the spermatic vessels described by Palomo 1949 and the subsequent modification by Bernardi can be easily performed laparoscopically with less postoperative pain and decreased length of hospital stay. All laparoscopic procedures can be safely employed with a low morbidity and the long term results do not show significant disadvantages compared to the traditional open techniques so far.