Projects

Laparoscopic Fowler–Stephens (FS) is an established surgery for the treatment of nonpalpable undescended testis (UDT) in pediatric patients. Single incision laparoscopic surgery (SILS) offers an obvious advantage by obviating the need for additional incisions in the abdomen and minimizing port‑related complications. A novel technique of single‑incision laparoscopic orchidopexy using a Foley catheter is elaborated below. Procedure A 24‑Fr triple‑lumen Foley catheter without bulb inflation is used as a flexible port. A segment of approximately 6 cm of the distal catheter is cut and utilized for the insertion of a 5 mm port with telescope in 1‑ and 3‑mm port with instrument in another lumen. A 5–8 mm linear incision is made at the proximal and distal ends of the 3 mm lumen to enhance the manoeuvrability of the instruments [Figure 1]. The instruments used include a 5 mm 30° angled camera and 3 mm working instruments (Maryland/hook cautery and scissors). A horizontal trans‑umbilical incision of 10 mm is performed, a number 24 Foley catheter is inserted and secured with a purse‑string suture of delayed absorbable material, stabilizing the Foley and the ports with instruments [Figure 2]. This offers a robust seal for the pneumoperitoneum. A 3‑mm Maryland is used to dissect the tissues surrounding the testicular vessels, which are subsequently coagulated and divided using 3 mm scissors. Advantages of This Modified Technique The innovative use of a simple Foley catheter to aid umbilical entry and its efficiency in producing a seal for pneumoperitoneum are unique. A notable advantage is the reduction in the time required for port insertion and closure compared to the conventional three‑port technique (5 mm, 3 mm, and 3 mm). In contrast to the SILS, where a 12–15 mm port is used, Foleys catheter offers a smaller incision entry site through the umbilicus, which best suits children as young as 1 year of age, along with unhindered mobility of the instruments within the abdomen, given the space constraints. In addition, postoperative pain is minimal, cosmetic results are satisfactory, with no testicular loss. Conclusion The use of a Foley catheter for a single incision laparoscopic stage I Fowler–Stephen’s procedure is a novel and effective technique for the treatment of nonpalpable UDT and is easily reproducible. The excellent cosmetic outcomes, coupled with the potential to reduce port‑related morbidity, pain, and operative time, make it a feasible alternative.