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...
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.
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.
ConclusionThis video shows how deep urinary endometriosis can be performed laparoscopically. Mastering suturing is essential to avoid complications.
This video describes a systematic stepwise approach for complete dissection of ovarian remnant in the setting of a previous ureteral re-implantation.
To identify and highlight preservation of the ureter and hypogastric nerve during excision of superficial endometriosis for the treatment of chronic pelvic pain.
Describe an unusual bilateral ureteral reimplantation due to endometriosis and a flowchart of a conservative decision making.
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.
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.
To present a successful remission of hydronephrosis, with laparoscopic surgery of complete excision for DIE lesion, and end-to-end anastomosis of left ureter.
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.