Original Article
Outcome of Laparoscopic Repair of Ureteral Injury: Follow-up of Twelve Cases

https://doi.org/10.1016/j.jmig.2011.09.011Get rights and content

Abstract

Study Objective

To review the feasibility of laparoscopic repair in cases of ureteral injuries occurring during gynecologic laparoscopy.

Design

Retrospective study (Canadian Task Force classification II-3).

Setting

Institution-specific retrospective review of data from a tertiary referral medical center.

Patients

Patients suffering from iatrogenic ureteral injuries diagnosed during or after surgery, and cases with deliberate ureteral resection and repair because of underlying disease.

Measurements and Main Results

We conducted a retrospective review of all (10 345) laparoscopic gynecologic surgeries performed in our institute between February 2004 and November 2008. Twelve cases (median: 45.5 years, range: 27–63) of ureter transections were diagnosed and repaired laparoscopically by endoscopists. Of these, 10 had previous surgeries, pelvic adhesions, or a large pelvic-abdominal mass. One patient had undergone a segmental resection and laparoscopic ureteroureterostomy for deep infiltrative endometriosis. Of the remaining 11 iatrogenic ureteral transections, 10 were repaired via laparoscopic ureteroureterostomy, whereas 1 had undergone a laparoscopic ureteroneocystostomy. One injury was recognized on the second postoperative day, but intraoperative recognition was attained in 11 cases. The median duration of double J stenting was 73 days. Three patients had development of strictures (between 42 and 79 days after surgery) treated with restenting, but 1 had to undergo an ureteroneocystostomy for ureter disruption when trying to restent. One patient had development of leakage of the anastomotic site but recovered with a change of the double J stent. Only 1 case required another laparotomy for ureteroneocystostomy. Laparoscopic primary repair of ureteral injury was successful for 11 of 12 patients. All the patients were well and symptom free at the conclusion of the study period.

Conclusion

Early recognition and treatment of ureteral injuries are important to prevent morbidity. Laparoscopic ureteroureterostomy could be considered in transections of the ureter where technical expertise is available. To the best of our knowledge, this is the largest series, to date, of ureteral repairs via laparoscopy.

Section snippets

Methods

This retrospective study was based on a review of medical records obtained from February 2004 through November 2008 at the Chang Gung Memorial Hospital Linkou Medical Center. We included all types of iatrogenic ureter injury that were diagnosed either during or after the intended surgery. Cases with deliberate ureteral resection and repair because of underlying disease were also included in this review. Experienced endoscopists repaired all cases laparoscopically. We excluded cases that had to

Results

We reviewed a total of 10 345 laparoscopic surgeries from February 2004 to November 2008. Twelve cases of ureter transections during laparoscopic surgery were repaired under laparoscopy. Among these 12 surgeries, 6 were laparoscopic hysterectomies, 3 were bilateral adnexectomies, 1 was a deliberate resection of endometriosis involving the ureter, 1 was a staging laparoscopy for endometrial cancer, and 1 was a laparoscopic radical hysterectomy for cervical cancer. Six primary surgeons were

Discussion

Many risk factors for laparoscopic complications are described in the literature. They include previous gynecologic operations, previous cesarean section, pelvic adhesions caused by endometriosis, large uterine size, malignancy, and surgery for prolapse 9, 10, 11, 12. All relate to the resultant anatomic distortions that arise from them, causing difficulties in the identification and dissection of the ureter during surgery. Some surgeons have even attributed the loss of depth perception,

Conclusion

Early recognition and treatment of ureteral injuries are of paramount importance to prevent further morbidity. In such instances, performing an end-to-end anastomosis over the injured site in the distal ureter may be clinically feasible because the reports so far have been encouraging. In addition, it offers us the option of a reimplantation surgery should any complications arise. It is also important that we standardize the postoperative monitoring and care of these patients to ensure the

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The authors have no commercial, proprietary, or financial interest and support in the products or companies described in the article.

1

Dr. Chien-Min Han and Dr Heng-Hao Tan contributed equally to this article.

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