LAPAROSCOPIC RESECTION OF INTRA-ABDOMINAL TESTICULAR TUMOR PAUL RUSSO, GREGORY GRIMALDI, AND KEVIN C. CONLON ABSTRACT Intra-abdominal testicular neoplasms are difficult to diagnose, with open surgical exploration and excision the traditional mode of therapy. We report a patient with an intra-abdominal seminoma resected laparo- scopically. In patients who present without evidence of retroperitoneal adenopathy, laparoscopy can be used for diagnosis, and with minimally invasive surgical techniques, to resect these tumors. UROLOGY 51: 122–124, 1998. © 1998, Elsevier Science Inc. All rights reserved. T he nonpalpable cryptorchid testis represents a diagnostic dilemma, and is usually not possi- ble to locate by clinical examination. The use of imaging modalities, including computed tomogra- phy (CT) scan, ultrasound, magnetic resonance imaging (MRI), venography, and other techniques is often unreliable. 1–4 Treatment of these patients has evolved from open surgical exploration toward the use of laparoscopy to confirm the location and resect the atrophic intra-abdominal testes, particu- larly in the pediatric population. 1 Patients with cryptorchid testis are at an in- creased risk of 3 to 48 times of developing germ cell tumors. 2,5,6 Approximately 10% of all testicular tu- mors arise from undescended testes. 2,6 The evolu- tion of laparoscopy and advanced laparoscopic techniques offers the urologist an alternative to open surgical exploration for the diagnosis and therapy of intra-abdominal testicular neoplasms. We present a patient in whom a planned laparo- scopic resection of an intra-abdominal testicular tumor was performed. CASE REPORT A 53-year-old white man presented to the Urol- ogy Service at Memorial Sloan-Kettering Cancer Center (MSKCC) for evaluation of abdominal pain and a left paravesical mass. The patient had a his- tory of a left cryptorchid testis. Ultrasound evalu- ation 2 years earlier suggested an inguinal location; however, groin exploration performed at an out- side institution did not locate the testis. Because of persistent lower abdominal pain, an abdominal CT scan was performed which demonstrated a large left paravesical mass (6.8  5.3 cm) (Fig. 1). Physical examination was remarkable only for a nonpalpable left testis. There was no evidence of adenopathy or an abdominal mass. Testicular tu- mor markers were normal. A provisional diagnosis of an intra-abdominal testicular tumor was made, and a decision was made to perform a laparoscopic resection of the presumed intra-abdominal testic- ular tumor. Laparoscopy was performed in the standard fash- ion using a multiport technique 7 with the patient placed in steep Trendelenburg position and with both arms tucked in at his sides. Laparoscopy re- vealed no evidence of metastatic disease, and con- firmed the presence of a large left paravesical tes- ticular tumor attached to the internal ring. Working 5-mm ports were placed in the right mid and right lower quadrants and 12-mm ports were placed in the periumbilical and suprapubic sites. The tumor was freed from adherent peritoneal structures, and care was taken to dissect the mass from the left iliac vein and artery. The vas deferens was divided between endo-hemaclips. An en- doGIA 3.5 stapler (U.S. Surgical Corporation, Nor- walk, Conn) was used to staple and divide the sper- matic vessels. A grasping forceps was used to place a plastic bag around the tumor. The pelvis was irrigated and no bleeding was observed. The 12-mm suprapubic site was extended to 30 mm From the Urology Service and the Division of Gastric and Mixed Tumor Surgery, Department of Surgery, Memorial Sloan-Ketter- ing Cancer Center, New York, New York Reprint requests: Paul Russo, M.D., Urology Service, Depart- ment of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021 Submitted: May 29, 1997, accepted (with revisions): July 21, 1997 CASE REPORT © 1998, ELSEVIER SCIENCE INC. 0090-4295/98/$19.00 122 ALL RIGHTS RESERVED PII S0090-4295(97)00467-6