Ureterolysis for Laparoscopic Hysterectomy

CONCLUSION Ureteric injury has significant morbidity and is the commonest reason for litigation following hysterectomy with an estimated risk of 0.02 - 0.4%. [1,2] Ureterolysis is infrequently practiced by benign gynaecologists however, is necessary during complex surgery. Benign pathology requiring hysterectomy such as endometriosis, fibroids, large uteri and adnexal masses are recognised risk factors for ureteric injury. [3] Most injuries occur during division of the uterine artery at the level of the internal cervical os. The average distance between the ureter and cervix is 2 cm but it is 0.5 cm in 3.2% of the population with a normal pelvis [4]. Preventative strategies such as use of a uterine manipulator may increase this distance though it may not be enough to prevent injury in those with normal anatomical variants and complex pathology. Visualising the ureter at the pelvic brim and side wall without retroperitoneal dissection may be inadequate because the segment of ureter, between intersection of the uterine artery and bladder, is not seen. The ureter can be safely dissected safely up to 15 cm without compromising its viability. In this educational video, we demonstrate various simple, quick and reproducible techniques to perform ureterolysis for complex benign pathology. These techniques can be used by both expert and novice surgeons to perform and teach ureterolysis. Our method, determines the course of the ureter throughout the pelvis and relation to the uterine a...
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research