Clinical efficacy of single-port transscrotal laparoscopic orchiopexy combined with hernia needle for palpable undescended testes in children

Abstract

Objective

To investigate the clinical efficacy and safety of single-port transscrotal laparoscopic orchiopexy combined with a hernia needle (SPLT-Orchiopexy) in children with palpable middle- and low-position undescended testes.

Methods

A retrospective analysis was conducted on 200 children with palpable middle- and low-position undescended testes who underwent surgical treatment at our hospital between March 2021 and April 2023. Patients were categorized into two groups according to the surgical technique used: the conventional laparoscopic surgery (CLS, n = 120) group and the SP-Orchiopexy group (n = 80). Perioperative indicators, postoperative pain assessed using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. Scar outcomes at 6 months postoperatively were evaluated using the Observer Scar Assessment Scale (OSAS) and the Patient Scar Assessment Scale (PSAS), which were compared between two groups. The incidence of postoperative complications was also compared between groups. Logistic regression analysis was performed to identify factors associated with postoperative complications.

Results

The SPLT-Orchiopexy group showed significantly shorter operative time, less intraoperative blood loss, earlier ambulation, and shorter length of hospital stay (t = 11.15–16.91, all P < 0.001). FLACC scores at 6, 12, and 24 h postoperatively were significantly lower in the SPLT-Orchiopexy group (Z = 4.67–6.91, all P < 0.001). At 6-month follow-up, both OSAS and PSAS scores were lower in the SPLT-Orchiopexy group (Z/t = 7.31–7.65, all P < 0.001). The overall incidence of postoperative complications was lower in the SPLT-Orchiopexy group (χ² = 4.68, P = 0.031). The surgical approach did not reach statistical significance as an independent predictor of postoperative complications, but it demonstrated a trend toward reduced complication risk (Wald = 1.49, P = 0.222).

Conclusion

SPLT-Orchiopexy may provide advantages in terms of minimal invasiveness, postoperative recovery, pain relief, cosmetic outcomes, and postoperative complications in children with palpable middle- and low-position undescended testes. Further prospective studies are warranted to validate these findings.

Introduction

Undescended testis is among the most common congenital anomalies of the pediatric genitourinary system, with an incidence of approximately 2%–4% in full-term male infants. If not treated in a timely and effective manner, undescended testis may impair spermatogenesis, disrupt endocrine function, and compromise long-term fertility. In addition, it is associated with an increased risk of testicular malignancy and inguinal-related complications [1, 2]. Therefore, achieving effective testicular descent and fixation while preserving vascular supply and function remains a central objective in pediatric surgery.

With advances in minimally invasive techniques, laparoscopic orchiopexy has gradually replaced traditional open surgery and become a standard approach for the treatment of undescended testis [3]. Laparoscopy offers advantages in testicular localization, exposure of spermatic cord anatomy, and management of the processus vaginalis, thereby reducing tissue injury and improving surgical success rate [4]. However, conventional laparoscopic surgery (CLS) still requires multiple abdominal wall incisions. Moreover, in cases of palpable middle- to low-position undescended testes, the surgical pathway may be relatively complex, and intraoperative traction on the spermatic cord and inguinal tissues can increase the risk of postoperative pain, scarring, and complications [5]. Transscrotal orchiopexy has attracted increasing attention in the management of palpable undescended testes because of its concealed incision and short operative pathway. Nevertheless, its limited ability to address the intra-abdominal processus vaginalis and internal inguinal ring restricts the applicability of this single approach [6].

In recent years, the introduction of single-port laparoscopic techniques and the minimally invasive concept of hernia needle application has provided new possibilities for optimizing surgical approaches for undescended testis. Single-port laparoscopy reduces abdominal wall trauma while maintaining adequate intra-abdominal visualization. Meanwhile, hernia needle techniques enable high ligation of the internal inguinal ring, effectively minimizing peritoneal disturbance and the risk of associated complications [7]. Theoretically, the combination of single-port laparoscopic transscrotal orchiopexy with hernia needle (SPLT-Orchiopexy) techniques may facilitate sufficient testicular mobilization and safe descent while further reducing perioperative trauma, alleviating postoperative pain, and improving cosmetic outcomes [8]. However, systematic evaluations of the clinical efficacy, safety, and complication risks of this combined approach in children with palpable middle- to low-position undescended testes remain limited, and robust evidence is still lacking.

Therefore, the present study conducted a retrospective cohort analysis of children with palpable middle- to low-position undescended testes to compare SPLT-Orchiopexy with conventional laparoscopic surgery in terms of perioperative outcomes, postoperative pain, scar assessment, and complication rates. The comparison in this study involved two minimally invasive surgical approaches applied to the same clinical indication. This study aims to evaluate the clinical value of this novel surgical strategy from perspectives of minimal invasiveness, safety, and clinical benefit. We also attempt to investigate the clinical efficacy and safety of SPLT-Orchiopexy surgery for the treatment of undescended testes, thereby providing clinical evidence to support the standardized application of this technique.

Materials and methods

Participants

This study was designed as a retrospective cohort study. A total of 200 consecutive children with palpable middle- to low-position undescended testes who underwent surgical treatment at our institution between March 2021 and April 2023 were enrolled. Patients were categorized into two groups based on the surgical technique employed. During the early study period, conventional laparoscopic orchiopexy was routinely performed at our institution, whereas the single-port laparoscopic transscrotal approach was gradually adopted in the later period. Children who underwent conventional laparoscopic orchiopexy between March 2021 and October 2022 were assigned to the CLS group (n = 120), whereas those treated with SPLT-Orchiopexy between November 2022 and April 2023 were assigned to the SPLT-Orchiopexy group (n = 80). All included patients underwent surgical for the same clinical indications throughout the study period. All procedures were performed by experienced pediatric surgeons at our institution, and perioperative management protocols were standardized to ensure comparability between groups.

The inclusion criteria were as follows: (1) a definite preoperative diagnosis of palpable undescended testis [9]; (2) age ≤ 12 years; (3) first-time surgical treatment; and (4) complete clinical data.

The exclusion criteria were as follows: (1) non-palpable or intra-abdominal undescended testis; (2) concomitant severe systemic diseases involving the heart, lungs, liver, or kidneys; (3) a previous history of inguinal or scrotal surgery; and (4) incomplete follow-up data.

Surgical procedures

Patients in the CLS group underwent conventional laparoscopic orchiopexy. The child was placed in the supine position, and the procedure was performed under general anesthesia. A transverse incision (~ 1.0 cm) was made below the umbilical margin to establish carbon dioxide (CO2) pneumoperitoneum, and a laparoscope was inserted for testicular localization. Two additional incisions of approximately 0.5-cm lateral incisions were created to accommodate 5-mm trocars as operative channels. Under direct visualization, the spermatic cord, testis, and vas deferens were dissected and mobilized with careful preservation of the spermatic vessels and vas deferens. After adequate mobilization of the spermatic cord, the testis was drawn down to the bottom of the scrotum. In cases in which the testis could not be sufficiently mobilized to the ipsilateral internal inguinal ring, further mobilization of the spermatic cord structures was performed to obtain adequate length while preserving the spermatic vessels and vas deferens. Subsequently, a scrotal dartos pouch was created, and the testis was fixed without tension. The patent processus vaginalis was managed, and the internal inguinal ring was closed. After confirmation of the absence of active bleeding and verification of the normal orientation of the spermatic cord, the instruments were withdrawn and the incisions were closed.

Patients in the SPLT-Orchiopexy group underwent the single-port laparoscopic transscrotal orchiopexy with high ligation of the internal ring (SPLT-Orchiopexy). The child was placed in the supine position, and the procedure was performed under general anesthesia. A 5-mm longitudinal umbilical incision was made to establish CO2 pneumoperitoneum, and a laparoscope was inserted as the observation channel. The operating table was adjusted to the Trendelenburg position to facilitate intra-abdominal manipulation. An approximately 8-mm incision was made at the middle-to-lower ipsilateral scrotum. The scrotal dartos was dissected to create an operative space, after which the dartos was incised and the testis was delivered extracorporeally through the scrotal incision. When necessary, the tunica vaginalis was opened to facilitate exposure of the testis, and the “bridge” technique was used to transect the peritoneum of the patent processus vaginalis along the spermatic cord. Dissection of the processus vaginalis and spermatic cord structures was then extended posterolaterally along the course of the testicular vessels to fully release adhesions to surrounding tissues, ensuring that the testis could reach the scrotum without tension. After confirming the absence of active bleeding and ensuring that there was no torsion of the spermatic cord or testis, the testis was fixed externally to the scrotal dartos. Under direct laparoscopic visualization, a hernia needle was then used to perform high ligation of the ipsilateral internal inguinal ring in an extraperitoneal manner. Contralateral indirect hernias, if present, were treated simultaneously. Final laparoscopic inspection confirmed absence of injury. Pneumoperitoneum was evacuated, the umbilical incision was closed with intradermal sutures, and medical tissue adhesive was applied. The key steps of the two surgical techniques are illustrated in Fig. 1.

Fig. 1.

Surgical procedures of conventional and single-port transscrotal laparoscopic orchiopexy. A Conventional laparoscopic approach and intracorporeal ligation procedure. B Transscrotal single-port approach and hernia-needle-assisted ligation procedure

Outcome measures

Perioperative indicators: operative time, time to postoperative ambulation, intraoperative blood loss, and length of hospital stay.

Postoperative pain: assessed using the validated Face, Legs, Activity, Cry, and Consolability (FLACC) Scale [10] at 6, 12, and 24 h postoperatively. The total FLACC score ranges from 0 to 10, with higher scores indicating more severe pain.

Postoperative scar assessment: postoperative scar outcomes at 6 months were evaluated using the Observer Scar Assessment Scale (OSAS) [11] and the Patient Scar Assessment Scale (PSAS) [12] based on available follow-up records and caregiver-reported assessments. Because of the retrospective nature of the study, outcome assessors were not blinded to the surgical technique.

Postoperative complications: included scrotal hematoma, incisional infection, testicular retraction, testicular atrophy, and recurrent hydrocele or indirect inguinal hernia

Follow-up: all patients were followed for 6 months after surgery through a combination of outpatient visits and telephone follow-up. All patients completed the scheduled follow-up, with a median follow-up duration of 6 months.

Statistical analysis

All data were analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). The Shapiro–Wilk test was used to assess the normality of continuous variables. Continuous variables with a normal distribution are presented as mean ± standard deviation (SD). Comparisons between groups were performed using the independent-samples t test. Non-normally distributed variables are presented as median (25th-75th percentile) and compared using the rank-sum test. Categorical variables are expressed as counts and percentages [n (%)] and were compared using the chi-square test (x²) or Fisher’s exact test, as appropriate. Variables that reached statistical significance (P < 0.05) in univariate analyses were entered into a multivariate logistic regression model to identify independent risk factors for postoperative complications, and odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated. A two-sided P < 0.05 was considered statistically significant.

Results

Baseline characteristics

No significant differences were observed between the CLS and SPLT-Orchiopexy groups regarding age and body weight (t = 0.64 and t = 0.74, both P > 0.05). Similarly, categorical variables including testis side and testis position showed no significant differences (χ² = 0.13 and 0.17, all P > 0.05), indicating good comparability of baseline characteristics between the groups (Table 1).

Table 1.

Baseline characteristics of children with undescended testes in both groups [± s, n (%)]

Variables	CLS group (n = 120)	SPLT-Orchiopexy group (n = 80)	t/x2	P
Age (year)	5.60 ± 2.33	5.39 ± 2.08	0.64	0.50
Body weight (kg)	22.80 ± 6.70	22.10 ± 6.40	0.74	0.46
Testis side			0.17	0.68
Unilateral	114 (95.0%)	77 (96.25%)
Bilateral	6 (5.0%)	3 (3.7%)
Testis position			0.13	0.72
Low position	72 (60.0%)	50 (62.5%)
Middle position	48 (40.0%)	30 (37.5%)
Associated inguinal hernia			0.26	0.61
Yes	15 (12.5%)	12 (15.0%)
No	105 (87.5%)	68 (85.0%)

Perioperative indicators

Compared with the CLS group, the SPLT-Orchiopexy group demonstrated significantly shorter operative time, lower intraoperative blood loss, earlier ambulation, and shorter hospital stay (t = 11.15–16.91, all P < 0.001), suggesting that SPLT-Orchiopexy was associated with reduced perioperative trauma and faster postoperative recovery (Table 2).

Table 2.

Comparison of perioperative indicators between the two groups [± s]

Variables	CLS group (n = 120)	SPLT-Orchiopexy group (n = 80)	t	P
Operative time (minutes)	56.11 ± 6.40	41.50 ± 5.30	16.91	< 0.001
Intraoperative blood loss (mL)	7.40 ± 1.61	5.00 ± 1.30	11.15	< 0.001
Ambulation (days)	3.80 ± 0.70	2.20 ± 0.60	16.72	< 0.001
Hospital stay (days)	6.60 ± 1.10	4.40 ± 0.90	14.91	< 0.001

Postoperative pain

Postoperative FLACC scores decreased over time in both groups. However, the SPLT-Orchiopexy group had significantly lower FLACC scores at 6, 12, and 24 h postoperatively compared with the CLS group (Z = 4.67–6.91, all P < 0.001), indicating more effective early postoperative pain control with SPLT-Orchiopexy (Table 3).

Table 3.

Comparison of FLACC scores at different postoperative time points between the two groups [M (P₂₅, P₇₅)]

Variables	CLS group (n = 120)	SPLT-Orchiopexy group (n = 80)	z	P
6 h postoperatively	6 (6, 7)	5 (5, 6)	6.91	< 0.001
12 h postoperatively	5 (4, 6)	4 (3, 5)	4.67	< 0.001
24 h postoperatively	4 (3, 5)	3 (3, 4)	5.24	< 0.001

Postoperative scar assessment

At 6-month follow-up, the SPLT-Orchiopexy group had significantly lower OSAS and PSAS scores compared with the CLS group (z = 7.65 and t = 7.31, all P < 0.001), suggesting that SPLT-Orchiopexy improves cosmetic outcomes and enhances caregiver satisfaction (Table 4).

Table 4.

Comparison of postoperative OSAS and PSAS scores between the two groups [M (P₂₅, P₇₅),±s]

Variables	CLS group (n = 120)	SPLT-Orchiopexy group (n = 80)	z/t	P
OSAS score	12 (11, 14)	9 (8, 11)	7.65	< 0.001
PSAS score	14.29 ± 3.14	11.16 ± 2.69	7.31	< 0.001

Postoperative complications

The overall incidence of postoperative complications was significantly lower in the SPLT-Orchiopexy group than in the CLS group (χ² = 4.68, P = 0.031, OR = 2.769, 95% CI: 1.069–7.172). The most frequent complications were scrotal hematoma and testicular retraction, while testicular atrophy and recurrent hydrocele or indirect inguinal hernia occurred less frequently (Table 5).

Table 5.

Comparison of postoperative complications between the two groups [n (%)]

Variables	CLS group (n = 120)	SPLT-Orchiopexy group (n = 80)	x 2	P
Scrotal hematoma	8 (6.7%)	2 (2.5%)
Incisional infection	4 (3.3%)	1 (1.3%)
Testicular retraction	5 (4.2%)	1 (1.3%)
Testicular atrophy	2 (1.3%)	0 (0.00%)
Recurrent hydrocele or indirect inguinal hernia	3 (2.5%)	1 (1.3%)
Total incidence	22 (18.33%)	6 (7.5%)	4.68	0.031

Factors associated with postoperative complications

Univariate analysis revealed that intraoperative blood loss, hospital stay, and surgical approach differed significantly between patients with and without complications (t = 2.07–3.19, χ² = 4.68, P < 0.05). Age, body weight, testis side, testis position, associated inguinal hernia, operative time, and time to ambulation showed no significant differences (P > 0.05) (Table 6). Variables with P < 0.05 in univariate analysis were included in a multivariate logistic regression model. Results showed that neither surgical approach nor intraoperative blood loss were independent predictors of postoperative complications (Wald = 0.80–1.49, P > 0.05). Notably, SPLT-Orchiopexy demonstrated a protective trend in reducing complication risk (OR < 1), although this did not reach statistical significance (Table 7).

Table 6.

Univariate analysis of factors associated with postoperative complications [± s, n (%)]

Variables	Without complications (n = 172)	With complications (n = 28)	t/x2	P
Age (year)	5.40 ± 2.19	5.56 ± 2.84	1.31	0.89
Body weight (kg)	22.34 ± 6.58	23.63 ± 6.52	0.63	0.34
Testis side			0.07	0.80
Unilateral	164 (95.35%)	27 (96.43%)
Bilateral	8 (4.65%)	1 (3.57%)
Testis position			1.42	0.23
Low position	87 (55.77%)	19 (67.86%)
Middle position	69 (44.23%)	9 (32.14%)
Associated inguinal hernia			0.53	0.47
Yes	22 (12.79%)	5 (17.86%)
No	150 (87.21%)	23 (82.14%)
Surgical methods			4.68	0.031
CLS	98 (56.98%)	22 (78.57%)
SPLT-Orchiopexy	74 (43.02%)	6 (21.43%)
Operative time	50.14 ± 9.42	51.00 ± 8.90	0.45	0.65
Intraoperative blood loss	6.33 ± 1.91	7.13 ± 1.68	2.07	0.04
Ambulation	3.12 ± 1.05	3.39 ± 0.83	1.31	0.19
Hospital stay	5.59 ± 1.44	6.53 ± 1.53	3.19	0.002

Table 7.

Multivariate logistic regression analysis of factors associated with postoperative complications

Variables	β	SE	Wald x2 value	p-value	OR	OR (95%CI)
						Lower limit	Upper limit
Constant	-2.417	1.072	5.085	0.024	0.089	-	-
Surgical methods	-0.721	0.59	1.494	0.222	0.486	0.153	1.545
Intraoperative blood loss	0.123	0.138	0.8	0.371	1.131	0.864	1.481

Discussion

This retrospective analysis systematically compared the clinical efficacy and safety of SPLT-Orchiopexy versus CLS in children with palpable middle- to low-position undescended testes. Under comparable baseline characteristics, the combined technique demonstrated advantages in perioperative indicators, postoperative recovery, early pain control, and scar outcomes, without an increased risk of major complications. These findings suggest that, with appropriate patient selection, further integration of minimally invasive surgical techniques may contribute to improved short-term perioperative outcomes while maintaining treatment safety. However, because no objective biological or inflammatory markers of surgical stress were evaluated in this study, interpretations regarding reduced surgical trauma should be made cautiously.

The primary goal of undescended testis surgery is to achieve stable, tension-free fixation of the testis in the scrotum while preserving testicular blood supply and spermatic cord integrity [13]. The choice of surgical pathway affects both the complexity of anatomical manipulation and the extent of local tissue injury, directly influencing postoperative recovery [14]. Conventional multi-port laparoscopic surgery offers clear advantages in testis localization and intra-abdominal anatomical exposure, but in managing palpable undescended testes, it often requires relatively long operative channels between the abdominal wall, inguinal region, and scrotum, which may increase unnecessary tissue dissection and traction [15, 16]. In contrast, the SPLT-Orchiopexy technique centralizes key operative steps within the scrotal region while utilizing single-port laparoscopy for essential intra-abdominal visualization and internal ring management, thereby simplifying the operative pathway and potentially reducing the extent of tissue manipulation and operative complexity. Previous studies have reported several minimally invasive approaches to orchiopexy, including CLS, single-site laparoscopic orchiopexy, and transscrotal orchiopexy [1, 17]. Laparoscopic techniques provide excellent visualization and facilitate management of the internal inguinal ring, whereas transscrotal approaches shorten the operative pathway and may reduce tissue trauma and postoperative discomfort [18]. A recent systematic review and meta-analysis [19] further demonstrated that laparoscopic orchiopexy for palpable cryptorchidism is a safe and effective minimally invasive approach with favorable surgical outcomes and complication profiles. The authors also highlighted the advantages of laparoscopic techniques in anatomical visualization and operative management for selected patients with palpable undescended testes. Compared with these techniques, the SPLT-Orchiopexy approach integrates the advantages of both techniques. This hybrid strategy allows precise intra-abdominal assessment while minimizing the number of abdominal ports and shortening the testicular descent pathway, which may contribute to improved perioperative recovery [20].

The observed improvements in perioperative indicators support this hypothesis. The SPLT-Orchiopexy group demonstrated shorter operative time and reduced intraoperative blood loss, suggesting improved efficiency in procedural workflow and tissue handling. However, these findings should also be interpreted in the context of potential temporal bias and learning-curve effects. Because SPLT-Orchiopexy was introduced during the later study period, increasing surgical experience, refinements in perioperative management, and institutional evolution over time may have partially contributed to the observed improvements in perioperative outcomes. Earlier ambulation and shorter hospital stay may further reflect improved postoperative recovery and perioperative efficiency [21]. Nevertheless, the duration of hospitalization reported in the present study remains longer than that commonly observed in healthcare systems where orchiopexy is routinely performed as a day-case procedure. This difference may limit the generalizability of our findings to other healthcare settings. Previous studies have demonstrated high parental satisfaction and favorable clinical outcomes for pediatric inguinoscrotal procedures performed in day-surgery settings [22]. Further optimization of perioperative management and implementation of day-surgery pathways may help improve healthcare efficiency in our institution in the future. These findings are consistent with previous studies suggesting that minimizing the number of surgical access points and reducing local tissue manipulation may contribute to improved postoperative recovery [23].

Postoperative pain is a key outcome for evaluating the benefits of pediatric minimally invasive surgery. Using the FLACC scale, our study showed overall lower pain scores in the SPLT-Orchiopexy group, indicating that the combined technique may mitigate early postoperative pain. This benefit may be attributed to fewer abdominal incisions, reduced inguinal dissection, and decreased traction on the spermatic cord [24]. However, because inflammatory or biochemical markers were not evaluated, the underlying mechanisms should be interpreted cautiously. Previous research has shown a close association between postoperative pain in children and the extent of soft tissue injury; our findings provide clinical evidence supporting the relationship between minimally invasive approaches and reduced pain response [25].

Scar outcomes were also significantly improved in the SPLT-Orchiopexy group, as demonstrated by both OSAS and PSAS scores. In pediatric patients, postoperative scars influence not only appearance but also psychological adaptation and family experience. The combination of a concealed scrotal incision and a single umbilical port allows necessary anatomical procedures while minimizing visible scarring, aligning with the current pediatric surgical principle of balancing function, safety, and cosmesis [8]. Nonetheless, scar outcomes may be influenced by individual variability and postoperative care, and thus should be interpreted with caution. In addition, OSAS and PSAS assessments were not performed in a blinded manner, which may have introduced observer-related assessment bias.

Complication analysis further supports the safety of the combined technique. Although univariate analysis suggested correlations between surgical approach, intraoperative blood loss, hospital stay, and complications, multivariate logistic regression adjusting for potential confounders did not identify any independent risk factors. This indicates that postoperative complications likely reflect the combined effects of multiple clinical factors rather than a single surgical technique. Notably, SPLT-Orchiopexy showed a trend toward reducing complication risk (OR < 1), although not statistically significant. Given the relatively low incidence of complications, this trend may still be clinically relevant. However, the relatively small number of complication events may have limited the statistical power of the multivariate regression analysis, and the model may therefore have been underpowered to detect independent predictors of postoperative complications.

From a technical perspective, the integration of multiple minimally invasive components may explain these findings. Single-port laparoscopy provides stable, clear intra-abdominal visualization to confirm testis position, spermatic cord course, and processus vaginalis status. The hernia needle enables extraperitoneal high ligation of the internal inguinal ring, reducing intra-abdominal manipulation and potential injury. Meanwhile, the transscrotal route shortens the testicular descent path, potentially lowering spermatic cord tension. Collectively, these features may help preserve testicular blood supply and decrease the risk of postoperative retraction. While these advantages are consistent with prior studies of individual minimally invasive techniques, long-term outcomes remain to be established.

This study has several limitations. First, its retrospective, single-center design may limit generalizability. In addition, as a retrospective study, the allocation of patients to different surgical techniques was influenced by the time period during which the procedures were adopted in our institution, which may introduce potential selection bias despite comparable surgical indications between groups. Temporal bias and learning-curve effects should also be considered, as progressive improvements in surgical proficiency, perioperative care pathways, and institutional experience over time may have affected perioperative outcomes independently of the surgical technique itself. Moreover, outcome assessments such as postoperative pain and cosmetic evaluation were derived from clinical records and follow-up documentation, and evaluators were not blinded to the surgical technique, which may introduce potential assessment bias. Furthermore, the follow-up period was relatively short, precluding comprehensive assessment of long-term testicular position stability, spermatogenic function, and endocrine outcomes. The limited number of complication events may reduce statistical power in multivariate analysis. Future studies should employ multicenter, prospective randomized controlled designs with larger sample sizes and longer follow-up duration. Integration of imaging and endocrine assessments will further clarify the long-term safety and functional outcomes of this combined approach.

Overall, this study provides a systematic analysis of SPLT-Orchiopexy for palpable middle- to low-position undescended testes across multiple perioperative and short-term outcome measures, offering preliminary evidence regarding its feasibility and short-term clinical outcomes. However, given the retrospective design, non-randomized allocation, and relatively short follow-up duration, these findings should be interpreted cautiously and require further validation in prospective multicenter studies with longer-term follow-up.

Conclusion

SPLT-Orchiopexy may offer potential advantages in terms of perioperative recovery, postoperative pain control, and cosmetic outcomes for children with palpable middle- to low-position undescended testes. In the present study, this technique showed favorable short-term clinical outcomes without an apparent increase in postoperative complications. However, given the retrospective design, non-randomized allocation, and relatively short follow-up duration, these findings should be interpreted cautiously and require further validation in prospective multicenter studies.

Authors’ contributions

Quan Lin and Shan Li contributed equally to the conceptualization and design of the study. Quan Lin was primarily responsible for data collection and analysis, while Shan Li played a key role in interpreting the results and drafting the manuscript. Weifeng Zhang, Jun Zhang and Qian Ding both contributed to data analysis and interpretation, and participated in writing and revising the manuscript. They also provided valuable feedback on the study’s methodology and analysis. Xiaofang Wang and Hui Shang contributed to the project’s overall management and provided critical feedback on the study’s design and implementation. They also contributed to writing and revising the manuscript. All authors played significant roles in the development of the study and approved the final version of the manuscript.

Funding

There is no fund support from any institution or individual for this research.

Data availability

The datas used and/or analyzed during the current study are available from the corresponding author.

Declarations

Ethics approval and consent to participate

This retrospective study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Human Ethics Committee of Shijiazhuang Maternal and Child Health Care Hospital (Ethics Approval Number: 202316). Given the retrospective nature of the study and the use of de-identified clinical data, the requirement for informed consent was waived by the ethics committee.

Consent for publication

Not applicable

Competing interests

The authors declare no competing interests.