Laparoscopic management of nonpalpable testes: A multicenter study of the Italian Society of Video Surgery in Infancy Alfonso Papparella a, * , Pio Parmeggiani a , Giovanni Cobellis b , Luciano Mastroianni b , Giuseppe Stranieri c , Nicola Pappalepore d , Girolamo Mattioli e , Ciro Esposito f , Mario Lima g a Division of Pediatric Surgery, Second University of Naples, 80131 Naples, Italy b Division of Pediatric Surgery, Salesi Hospital, 60123 Ancona, Italy c Division of Pediatric Surgery, Pugliese Hospital, 88100 Catanzaro, Italy d Division of Pediatric Surgery, Spirito Santo Hospital, 65124 Pescara, Italy e Division of Pediatric Surgery, G. Gaslini Hospital, 16148 Genova, Italy f Division of Pediatric Surgery, Magna Graecia University, 88100 Catanzaro, Italy g Division of Pediatric Surgery, University of Bologna, 40138 Bologna, Italy Abstract Purpose: Diagnostic laparoscopy has changed the surgical approach to nonpalpable testes (NPT). The aim of this study was to determine the value of laparoscopy in managing patients with NPT and to suggest guidelines for the interpretation of laparoscopic findings. The authors report the results of a multicenter study of the Italian Society of Video Surgery in Infancy on laparoscopic management of NPT. Methods: Between 1993 and 2001, the authors collected records of 364 patients with NPT who underwent laparoscopy, for a total of 388 testicular units. Results: Intraabdominal testes were found in 124 (34%) cases, for a total of 137 testes; 83 testicular units were classified as low and 54 as high. A total of 155 (43%) patients had cord structures entering the internal inguinal ring, 79 (22%) had intraabdominal blind-ending cord structures, and 6 (1%) had testicular agenesia. Conclusions: Laparoscopy is a valuable tool in diagnosing and treating more than 50% of cases of NPT. The laparoscopic evaluation of abdominal testes can provide indications for the most suitable surgical technique; moreover, in 23% of patients, it makes abdominal exploration unnecessary. The value of laparoscopy is even greater if the anatomical aspect of the internal ring and spermatic cord structures is carefully evaluated. D 2005 Elsevier Inc. All rights reserved. Since 1976, the use of laparoscopy in the management of cryptorchid nonpalpable testes (NPT) has gained growing recognition [1]. An incidence of cryptorchidism of about 1% is reported by age 1 year [2]. About 20% of children with 0022-3468/05/4004-0014$30.00/0 D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2005.01.010 T Corresponding author. Pediatric Surgery Clinic, Second University of Naples Medical School, 80131 Naples, Italy. Tel.: +39 81 566 6690; fax: +39 81 566 6683. E-mail address: alfonso.papparella@unina2.it (A. Papparella). Index words: Nonpalpable testis; Laparoscopy; Cryptorchidism Journal of Pediatric Surgery (2005) 40, 696 – 700 www.elsevier.com/locate/jpedsurg