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Prof. Dr. Ali Avanoğlu
Undescended Testicle • Diagnosis and evaluation

Diagnostic Laparoscopy: A Look Inside the Abdomen and the Path for Every Finding

Diagnostic laparoscopy (a minimally invasive procedure) is direct visualization of the inside of the abdomen through a thin camera introduced at the navel, and it's the only method that definitively answers both 'is there a testicle' and 'where' in a non-palpable testicle. This page explains how the procedure is performed and how the plan proceeds for every possible finding.

Who this is forFamilies of children for whom laparoscopy has been recommended because of a non-palpable testicle
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ByProf. Dr. Ali AvanoğluUpdated
This page is part of undescended testicle.Read the full treatment overview on the hub page
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inside the abdomen
01 · Why is laparoscopy the 'gold standard'?02 · How is it done?03 · Possible findings, and the path for each04 · When no testicle is found: why this, too, is an answer05 · Risks, recovery, and after surgery
In brief5 madde
  • Why is laparoscopy the 'gold standard'?: Ultrasound and MRI don't provide a reliable answer for a non-palpable testicle; if examination under anesthesia fails to find the testicle, only one definitive path…
  • How is it done?: The child is under general anesthesia.
  • Possible findings, and the path for each: The finding encountered on laparoscopy determines how the surgery continues.
  • When no testicle is found: why this, too, is an answer: For a family, the hardest news is that the testicle doesn't exist; but the information laparoscopy provides here is not uncertainty — it's a definitive answer, and it…
  • Risks, recovery, and after surgery: In experienced hands, diagnostic laparoscopy is a safe procedure; risks such as bleeding at the entry site, infection, or, rarely, injury to internal organs have been…
01

Why is laparoscopy the 'gold standard'?

Ultrasound and MRI don't provide a reliable answer for a non-palpable testicle; if examination under anesthesia fails to find the testicle, only one definitive path remains: seeing directly inside the abdomen. Laparoscopy does this through incisions just a few millimeters long, without opening the abdominal wall, and is recommended in the guidelines as the diagnostic method for a non-palpable testicle.

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  • The strength of this method is that it doesn't just allow viewing — it allows moving straight into treatment in the same session. If a testicle is found inside the abdomen, it can be brought down to the scrotum with laparoscopic orchiopexy under the same anesthetic; if a remnant is found, it can be removed; and if it turns out there is no testicle, the family is spared an unnecessary groin operation.
  • In our practice, this procedure is performed jointly by two pediatric urologists; two sets of eyes — one operating the camera, one assessing the finding — provide added confidence, especially when interpreting small or hidden structures.
02

How is it done?

The child is under general anesthesia. Through an incision just a few millimeters long, made inside or right at the edge of the navel, carbon dioxide gas is introduced into the abdomen; this moves the abdominal wall away from the organs and opens up the field of view. A thin camera (laparoscope) is placed through this same incision.

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  • The camera is first directed to the area where the testicle should normally be, the internal ring (the abdominal-side opening of the inguinal canal). Three structures are looked for here: the testicular vessels, the vas deferens (sperm duct), and, if present, the testicle itself. The opposite side is always checked as well.
  • If the procedure is diagnostic only, it takes just a few minutes. If treatment follows, one or two additional small incisions are made in the lower sides of the abdomen, and instruments are used to operate. At the end of the procedure the gas is released and the incisions are closed with dissolvable stitches; the scar at the navel becomes nearly invisible over time.
03

Possible findings, and the path for each

The finding encountered on laparoscopy determines how the surgery continues. Because these findings can't be known in advance, all of them are explained during the consent conversation, and the decision is made during surgery through the joint evaluation of the two surgeons.

  • Testicle inside the abdomen, vessels adequate → laparoscopic orchiopexy, same session
  • High intra-abdominal testicle, vessels short → staged approach (Fowler–Stephens or Shehata)
  • Peeping testis → usually single-stage descent
  • Vessels entering the canal → groin exploration; testicle brought down or remnant removed
  • Blind-ending vessels → vanishing testis; no further surgery
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  • Testicle inside the abdomen: the testicle is seen above the internal ring, inside the abdomen. If it's close to the internal ring and its vessels are long enough, it's brought down to the scrotum with laparoscopic orchiopexy in the same session. If it's too high up and the vessels are too short to reach the scrotum, rather than forcing the testicle down, one of the staged approaches is planned (Fowler–Stephens or Shehata); the first stage is usually performed in the same session.
  • Peeping testis: the testicle sits right at the edge of the internal ring, moving back and forth between the abdomen and the inguinal canal. This group is usually brought down to the scrotum in a single stage, either laparoscopically or through the groin.
  • Vessels and vas deferens entering the inguinal canal: the testicle, or its remnant, is in the groin. In this case the groin is opened (inguinal exploration). If a viable testicle is found, it's brought down to the scrotum; if a small, firm, non-functioning remnant (nubbin) is found, it's removed. If the structures entering the canal are thin and underdeveloped, the likelihood of a remnant is high.
  • Blind-ending vessels: if the testicular vessels taper off and end at a point inside the abdomen with no testicular tissue visible, the testicle was lost before birth due to a circulation problem — this is called a vanishing testis. In this case there is no testicle to bring down, the groin doesn't need to be opened, and no further surgery is needed.
04

When no testicle is found: why this, too, is an answer

For a family, the hardest news is that the testicle doesn't exist; but the information laparoscopy provides here is not uncertainty — it's a definitive answer, and it removes the need for unnecessary groin surgeries, repeated imaging, and years of wondering.

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  • In a unilateral vanishing testis, the other testicle is usually healthy, and most boys go on to have normal reproductive capacity as adults. To protect the remaining single testicle, self-examination is taught from adolescence onward, and follow-up continues with the same team. A testicular prosthesis for appearance can be discussed later; its timing is decided in adolescence, based on the young person's own preference.
  • Finding no testicle on either side is much rarer and is addressed together with the hormonal and genetic evaluation that should already have been done before surgery.
05

Risks, recovery, and after surgery

In experienced hands, diagnostic laparoscopy is a safe procedure; risks such as bleeding at the entry site, infection, or, rarely, injury to internal organs have been reported in the literature at very low rates. The gas introduced into the abdomen is released at the end of the procedure; mild shoulder or abdominal discomfort may occur for a few days.

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  • Most children who undergo only diagnostic laparoscopy or a single-stage descent go home the same day. Simple pain relievers are enough in the first few days; the small dressing at the navel is removed within a few days. At follow-up, the testicle's position in the scrotum and the navel incision are checked; if the testicle was brought down, follow-up continues with a few visits in the first year, then annual examinations.
  • If a staged approach was needed, the timing of the second stage (roughly six months for Fowler–Stephens, about twelve weeks for Shehata) is clearly communicated to the family right after surgery; the child continues their normal life in between.
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Frequently asked questions
Is laparoscopy only for looking, or is surgery done at the same time?
Both. The viewing part is diagnostic; if a testicle is found, it's brought down with laparoscopic orchiopexy under the same anesthetic, or the first step of the staged approach is performed. The family only has to hand their child over for a second anesthetic if the planned staged approach is used.
Will there be a scar at the navel?
Because the incision is placed inside or at the edge of the navel, the scar usually disappears into the navel's natural fold. The additional entry points are only a few millimeters and fade over time.
If no testicle is found, when is a prosthesis considered?
Placing a prosthesis in infancy isn't recommended, both because it would need replacing as the scrotum grows and because it should be the young person's own decision. It can be discussed in adolescence, once the scrotum has finished developing, if desired, and planned by the same team.
If the other testicle is much larger, is laparoscopy still needed?
Yes. An enlarged other testicle can point to a lost testicle on the affected side, but this alone isn't conclusive — a viable testicle may still be found inside the abdomen. The guidelines don't recommend skipping laparoscopy based on this finding.
Prof. Dr. Ali Avanoğlu's publications on this topic · 1
  1. Korkmaz Ö, Özen S, Özcan N, et al. (2017). Persistent Müllerian Duct Syndrome with Transverse Testicular Ectopia: A Novel Anti-Müllerian Hormone Receptor Mutation. Journal of clinical research in pediatric endocrinology. PubMed ↗
←Previous • Diagnosis and evaluationExamination Under AnesthesiaNext • Diagnosis and evaluationBilateral Non-Palpable Testicle→
Related pagesFull index →
Surgery in childrenLaparoscopic OrchiopexyFor a non-palpable testicle, both diagnosis and treatment begin with laparoscopy (a minimally invasive technique). A thin camera inserted through the navel shows whether the testicle exists and where it lies; if the testicle is inside the abdomen and its vessels are long enough, it is brought down into the scrotum with laparoscopic orchiopexy in the same session.Surgery in childrenPeeping TestisA peeping testis is an undescended testicle that sits right beside the internal ring, moving back and forth between the abdomen and the inguinal canal. It is usually not palpable on examination, but its vessels are often long enough; for this reason, it can generally be brought into the scrotum in a single stage, with either laparoscopic or inguinal orchiopexy.Special situationsVanishing TestisVanishing testis refers to a testicle that formed in the womb but was lost at some point in development when its blood supply was disrupted. It is one of the most common causes of a non-palpable testicle; the diagnosis is made at laparoscopy when blind-ending vessels are seen, meaning there is no testicle left to bring down.Special situationsAtrophic Testicular Remnant (Nubbin)A nubbin (atrophic testicular remnant) is a few millimeters of non-functional tissue left behind from a testicle whose blood supply was disrupted before birth, usually found in the inguinal canal or the upper scrotum. It is frequently encountered during the workup of a non-palpable testicle; most centers recommend removing it and sending it for pathological examination.
Undescended Testicle topic clustersMain treatment page →
Basics 7Diagnosis and evaluation 6Surgery in children 10Special situations 4After surgery 6Adolescents and adults 6Follow-up 3
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