The primary 5 mm camera port was introduced by open technique (inferior rim of the umbilicus on its internal surface), pneumoperitoneum was created (10mmHg) with the patient in a 30[degrees] head-down Trendelenburg position, the area of the internal inguinal ring
was inspected bilaterally, and subsequent trocars (all 5 mm) were placed under laparoscopic (30[degrees] telescope) visualization into the right and left lumbar region in line with the umbilical port.
Through inguinal incision, the mass was removed in bloc with the right testis, the spermatic cord, and the soft tissues to the internal inguinal ring
. Histopathological examination found a sclerosing variant of a grade 1 well-differentiated liposarcoma of 80 * 80 mm.
Other terms used to describe the position of the palpable testis are peeping (sliding in and out of the internal inguinal ring
), canalicular, extra-canalicular (super-ficial inguinal pouch), suprapubic (high scrotal/gliding), or ectopic.
In the description of the original technique for the placement of bilayer patch device (Ethicon, Prolen Hernia System[R], PHS), which is a three-dimensional double layer device, the connector of the PHS has a role of a 'plug in', which is positioned in internal inguinal ring
, very close to the spermatic cord and in contact with the genital branch of genitofemoral nerve, ilioinguinal nerve, and sympathetic nerves (testicular plexus)(1,2).
The laparoscopic approach enables occlusion of the internal inguinal ring
(MARIEN, 2001; BOENING et al., 2007; CARON & BRAKENHOFF, 2008; WILDERJANS et al., 2009) and can be used to prevent recurrences following emergency surgical intervention.
The lesions showed continuity through the internal inguinal ring
and extended to parauterine space and myometrium (Fig.
Our practice traditionally uses an inguinal incision because it provides excellent exposure and ability to easily ligate the patent processus vaginalis, if present, at the level of internal inguinal ring
. Further, it is our experience that the inguinal incision, when made in a normal skin crease, results in a cosmetically appealing scar and with a small incision minimizes postoperative discomfort.
Due to high association with indirect inguinal hernia, dissection to the internal inguinal ring
and ligation of the neck of the processus vaginalis should be performed.
Moreover, it is difficult to use USG to scan a testis cephalic to the internal inguinal ring
. The ectopic testis is identified by the presence of characteristic bright signal on T2-W images and a linear low-signal structure which may represent the remnant of the gubernaculums testis on MRI.