Vesico-ureteral injury during benign hysterectomy: minimally-invasive laparoscopic surgery versus laparotomy

The objectives of our study were to (i) examine the rate of vesico-ureteral injury at benign hysterectomy by surgical approach and (ii) compare the risk of vesico-ureteral injury specifically between minimally-invasive laparoscopic and abdominal hysterectomy on a populational level.DesignRetrospective population-based observational study.SettingThe National Inpatient Sample.Patients501,110 women who underwent hysterectomy for benign gynecological disease from 1/2012-9/2015 were included: total abdominal hysterectomy (TAH, n=284,365 [56.7%]), total laparoscopic hysterectomy (TLH, n=60,410, [12.1%]), abdominal supracervical hysterectomy (Abd-SCH, n=55,655 [11.1%]), laparoscopic-assisted vaginal hysterectomy (LAVH, n=45,620 [9.1%]), total vaginal hysterectomy (TVH, n=34,865 [7.0%]), and laparoscopic supracervical hysterectomy (LSC-SCH n=20,195 [4.0%]).InterventionsA comprehensive risk assessment for vesico-ureteral injury by hysterectomy mode was performed, adjusting for patient demographics and gynecologic disease types. Propensity score inverse probability of treatment weighing (PS-IPTW) was used to compare (i) TLH versus TAH and (ii) LSC-SCH versus Abd-SCH with generalized estimating equations. In a sensitivity analysis, gynecologic disease-specific injury risk and vaginal route-specific injury risk (LAVH versus TVH) were assessed.Measurements and Main ResultsVesico-ureteral injury was reported in 1,045 (0.21%) women overall. LAVH (0.28%) had the highest bladder injury r...
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research

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ConclusionUreteral endometriosis can lead to severe consequences, the surgical treatment can be difficult and most of the times incomplete. This video is a detailed example of our team strategy to perform a termino-terminal ureteral laparoscopic anastomosis in a structured way.
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
We present the case of a 29 year-old G0 with a past history of ureteral obstruction and hydroureteronephrosis due to deeply infiltrating endometriosis requiring left ureterolysis, complete left parametrectomy, and left salpingo-oophorectomy. She now presents with recurrent pelvic pain and a new right adnexal mass consistent with an endometrioma requiring surgical intervention.
Source: The Journal of Minimally Invasive Gynecology - Category: OBGYN Authors: Tags: IMAGES IN Gynecological Surgery Source Type: research
ConclusionThis video shows how deep urinary endometriosis can be performed laparoscopically. Mastering suturing is essential to avoid complications.
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
This video describes a systematic stepwise approach for complete dissection of ovarian remnant in the setting of a previous ureteral re-implantation.
Source: The Journal of Minimally Invasive Gynecology - Category: OBGYN Authors: Tags: Virtual Poster Session 3: Endometriosis (9:50 AM – 10:00 AM) 9:50 AM: STATION T Source Type: research
To identify and highlight preservation of the ureter and hypogastric nerve during excision of superficial endometriosis for the treatment of chronic pelvic pain.
Source: The Journal of Minimally Invasive Gynecology - Category: OBGYN Authors: Tags: Virtual Poster Session 3: Endometriosis (9:50 AM – 10:00 AM) 9:50 AM: STATION Q Source Type: research
Describe an unusual bilateral ureteral reimplantation due to endometriosis and a flowchart of a conservative decision making.
Source: The Journal of Minimally Invasive Gynecology - Category: OBGYN Authors: Tags: Virtual Poster Session 3: Endometriosis (9:50 AM – 10:00 AM) 9:50 AM: STATION M Source Type: research
We present a case of extrinsic urethral endometriosis. We review the peri-operative management with renal function testing, pre-operative imaging and stent placement. The patient had a robotic-assisted ureteroneocystostomy with psoas hitch for her severe disease. The goal of this video is to review peri-operative management of urinary tract endometriosis and to demonstrate the surgical technique of ureterolysis in extrinsic ureteral endometriosis and ureteroneocystostomy with psoas hitch.
Source: The Journal of Minimally Invasive Gynecology - Category: OBGYN Authors: Tags: Virtual Poster Session 3: Endometriosis (10:10 AM – 10:20 AM) 10:10 AM: STATION B Source Type: research
This video demonstrates a safe and effective minimally invasive technique for enterolysis, oophorectomy and subsequent ureterolysis in the face of deep infiltrating (DIE) and deep fibrotic endometriosis.
Source: The Journal of Minimally Invasive Gynecology - Category: OBGYN Authors: Tags: Virtual Poster Session 3: Endometriosis (10:20 AM – 10:30 AM) 10:20 AM: STATION L Source Type: research
To present a successful remission of hydronephrosis, with laparoscopic surgery of complete excision for DIE lesion, and end-to-end anastomosis of left ureter.
Source: The Journal of Minimally Invasive Gynecology - Category: OBGYN Authors: Tags: Virtual Poster Session 3: Endometriosis (10:20 AM – 10:30 AM) 10:20 AM: STATION B Source Type: research
To demonstrate methods to compensate for large ureteral defects after extensive resection of ureteral endometriosis. I will present 3 methods, the psoas hitch, the Boari flap and ileal interposition.
Source: The Journal of Minimally Invasive Gynecology - Category: OBGYN Authors: Tags: Open Communications 17:  Laparoscopy (11:00 AM – 12:45 PM) 12:03 PM Source Type: research
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