CPT® Code 54692

1. Indications

The laparoscopic orchiopexy procedure is indicated for the following conditions:

• Cryptorchidism - A condition where one or both testicles have not descended into the scrotum, specifically when the testis is located intra-abdominally.

2. Procedure

The laparoscopic orchiopexy procedure involves several key steps to ensure successful repositioning of the testis into the scrotum:

• Step 1: The patient is positioned supine in a Trendelenburg position to facilitate access to the abdominal cavity. A Foley catheter is placed transurethrally to manage the bladder during the procedure.
• Step 2: A small U-shaped skin incision is made at the umbilicus. A clamp is used to dissect down to the anterior rectus fascia, which is then opened slightly to allow the introduction of a Veress needle into the peritoneal cavity.
• Step 3: A pneumoperitoneum is created by insufflating carbon dioxide (CO2) into the abdominal cavity. This establishes a working space for the laparoscopic instruments.
• Step 4: With upward traction on the abdominal wall, a laparoscope is inserted through the umbilical incision, and additional trocars are placed into the abdomen along the mid-clavicular line for instrument access.
• Step 5: The abdominal organs are identified and inspected. Dissection begins lateral to the testis and spermatic cord at the gubernaculum near the internal inguinal ring to free the testis.
• Step 6: The gubernaculum is divided, and the peritoneum is incised and elevated off the spermatic vessels to mobilize them.
• Step 7: The testis is grasped and stretched toward the contralateral inguinal ring to evaluate the length of the spermatic cord. If additional mobility is needed, a triangular section of peritoneum between the spermatic vessels and the vas deferens is incised.
• Step 8: Once adequate length of the spermatic cord is achieved, a small transverse incision is made in the hemiscrotum ipsilateral to the testis. A subdartos pouch is created by dissecting the scrotal skin from the underlying dartos muscle.
• Step 9: A trocar is introduced through the scrotal incision and manipulated through the external inguinal ring lateral to the bladder and into the abdomen.
• Step 10: The testis is grasped and delivered to the subdartos pouch, where it is sutured to the scrotal septum to anchor it in the new location.
• Step 11: The scrotal incision is closed, and the laparoscopic instruments are withdrawn. CO2 is removed from the abdominal cavity, followed by closure of the fascia and skin.

3. Post-Procedure

After the laparoscopic orchiopexy, the patient is monitored for any immediate postoperative complications. Expected recovery includes some discomfort at the incision sites, which can be managed with analgesics. Patients are typically advised to avoid strenuous activities for a specified period to ensure proper healing. Follow-up appointments are necessary to assess the position of the testis and overall recovery. Any signs of complications, such as infection or issues with the testis position, should be reported to the healthcare provider promptly.