Research Article In Which Patients and Why Is Laparoscopy Helpful for the Impalpable Testis? Alfonso Papparella , Giuseppina Rosaria Umano , Mercedes Romano, Giulia Delehaye , Salvatore Cascone, Letizia Trotta, and Carmine Noviello Pediatric Surgery Unit, Department of Women Children General and Specialist Surgery, Campania University “Luigi Vanvitelli”, Naples, Italy Correspondence should be addressed to Alfonso Papparella; alfonso.papparella@unicampania.it Received 30 June 2022; Accepted 8 September 2022; Published 30 September 2022 Academic Editor: Imtiaz Wani Copyright © 2022 Alfonso Papparella et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Since laparoscopy has been proposed in the management of the nonpalpable testis (NPT), this technique has been widely diffused among pediatric surgeons and urologists, but its application is still debated. We conducted a retrospective review to highlight how diagnostic and surgical indications for laparoscopy are selective and should be targeted to individual patients. From 2015 to 2019, 135 patients with NPT were admitted to our surgical division. Of these, 35 were palpable on clinical examination under anesthesia and 95 underwent laparoscopy. e main laparoscopic findings considered were: intra-abdominal testis (IAT), cord structures that are blind-ending, completely absent, or entering the abdominal ring. e patients’ mean age was 22 months. In 48 cases, an IAT was found, and 42 of these underwent primary orchidopexy while 6 had the Fowler–Stephens (FS) laparoscopic procedure. Of the first group one patient experienced a testicular atrophy while two a reascent of the testis. In the FS orchidopexy group, one patient had testicular atrophy. Cord structures entering the internal inguinal ring were observed in 35 children, and all were surgically open explored. In 3 cases of these, a hypotrophic testis was revealed and an open orchidopexy was executed. In the remaining the histological examination revealed viable testicular cells in four patients and fibrosis, calcifications, and hemosiderin deposits in the others. Eleven patients presented with intrabdominal blind-ending vessels and one a testicular agenesia. A careful clinical examination is important to select patients to submit to laparoscopy. Diagnostic laparoscopy, and therefore, the ana- tomical observation of the testis and cord structures are strictly related to develop a treatment plan. In IAT, many surgical strategies can be applied with good results. Laparoscopy offers a concrete benefit to the patient. 1. Introduction e advent of minimally invasive techniques has improved the surgical approach for a wide range of diseases, especially in children, and laparoscopy has undergone significant development over the last few years. Notably, the application of laparoscopy has proved very beneficial in the diagnosis and treatment of nonpalpable testis (NPT) [1, 2]. Approx- imately 20% of patients with cryptorchidism have an NPT [2]. A testicle is defined as being nonpalpable when located in the abdominal cavity at a variable distance from the internal inguinal ring, in the inguinal canal with a different degree of development, or even absent/or ectopic [2–4]. It is also possible that the testis may have disappeared in utero (a condition known as “vanishing testis,” in which the cord structures end blindly) due to the torsion or vascular ac- cidents that occur during the testicular migration [3, 4]. Patients with bilateral NPT and clinical signs of abnormal sexual differentiation (i.e., hypospadias) require both en- docrinological and genetic evaluation [4, 5]. We think that laparoscopy facilitates the diagnostic and surgical strategies for NPT, although such procedures are selective and should be targeted to patients on a case-by-case basis [3]. erefore, clinical examination is particularly important in these pa- tients, and it must be repeated several times even during anesthesia before surgery. In an effort to locate an NPT, or to Hindawi Minimally Invasive Surgery Volume 2022, Article ID 1564830, 6 pages https://doi.org/10.1155/2022/1564830