A patent processus vaginalis is a requirement for a laparoscopic orthotopic staged spermatic vessel-sparing procedure for intra-abdominal undescended testis

PURPOSE: Laparoscopic orthotopic traction orchidopexy is a modification of the Shehata orchidopexy approach. Spermatic cord length is achieved by passing the testis through the inguinal canal, under tension, and securing the testis to the ipsilateral scrotal base. Spermatic vessels are not divided. Following intra-operative review of this technique, we present practical considerations. METHODS: We attempted the laparoscopic orthotopic traction approach in a 2-year-old boy presenting with bilateral undescended testes. RESULTS: In the presence of a closed deep inguinal ring, traction of testis into the scrotum is necessarily non-orthotopic and increases risks associated with the procedure. CONCLUSION: A closed ring should be considered a contra-indication to performing laparoscopic orthotopic traction orchidopexy.