Original ArticleOutcome of Laparoscopic Repair of Ureteral Injury: Follow-up of Twelve Cases
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
References (28)
- et al.
Ureteral injury. Complication of laparoscopic sterilization
Urology
(1974) - et al.
Urinary tract injury in laparoscopic-assisted vaginal hysterectomy
J Minim Invasive Gynecol
(2007) - et al.
Prevention of ureteral injuries in gynecologic surgery
Am J Obstet Gynecol
(2003) - et al.
Management of ureteral injuries
Ann Chir
(2005) - et al.
Predicting risk of complications with gynecologic laparoscopic surgery
Obstet Gynecol
(1998) - et al.
Iatrogenic ureteral lesions and repair: a review for gynecologists
J Minim Invasive Gynecol
(2007) - et al.
Laparoscopic repair of ureteral injuries
J Am Assoc Gynecol Laparosc
(2003) - et al.
Laparoscopic ureteroureteral anastomosis on the distal ureter
J Am Assoc Gynecol Laparosc
(2001) - et al.
Laparoscopic repair of ureteral transection
J Am Assoc Gynecol Laparosc
(2000) - et al.
Robotic-assisted laparoscopic ureteral reimplantation with psoas hitch: a multi-institutional, multinational evaluation
Urology
(2008)
A prospective multi-centre study of major complications experienced during excisional laparoscopic surgery for endometriosis
Eur J Obstet Gynecol Reprod Biol
Laparoscopic ureteroureterostomy: a prospective follow-up of 9 patients
Prim Care Update Ob Gyns
Urinary tract endometriosis treated by laparoscopy
Fertil Steril
Diagnosis and management of serious urinary complications after major operative laparoscopy
Obstet Gynecol
Cited by (0)
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.