Vesicoureteral Injury during Benign Hysterectomy: Minimally Invasive Laparoscopic Surgery versus Laparotomy
The objectives of our study were to (1) examine the rate of vesicoureteral injury on benign hysterectomy by the surgical approach and (2) compare the risk of vesicoureteral injury specifically between minimally invasive laparoscopic and abdominal hysterectomy on a populational level.DesignRetrospective population-based observational study.SettingThe National Inpatient Sample.PatientsA total of 501 110 women who had undergone hysterectomy for benign gynecologic disease between January 2012 and September 2015 were included as follows: 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 vesicoureteral injury by hysterectomy mode was performed, adjusting for patient demographics and gynecologic disease types. Propensity score inverse probability of treatment weighing was used to compare (1) TLH versus TAH and (2) 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 vs TVH) were assessed.Measurements and ...
To illustrate the surgical management of advanced endometriosis causing extrinsic ureteral compression.
Publication date: Available online 10 April 2020Source: Journal of Minimally Invasive GynecologyAuthor(s): Diego Raimondo, Giulia Borghese, Mohamed Mabrouk, Alessandro Arena, Marco Ambrosio, Simona Del Forno, Eugenia Degli Esposti, Paolo Casadio, Giulia Mattioli, Manuela Mastronardi, Renato Seracchioli
ConclusionsRobotic excision of urological endometriosis represents a safe and effective treatment option, since a limited rate of surgical complications was recorded even in cases of multi-organ disease.
Abstract The main objective of this paper by Wolf et al is to retrospectively evaluate if preservation of the mesureter within the context of total mesometrial resection for cervical cancer results in fewer ureteric complications (BJOG 2020 xxxx). They observe a 3% prevalence of ureteral complications versus 11% prevalence (P=0.049) if there was preservation of the mesureter. The main principles of this surgery is preservation of lateral ureteral blood supply during mobilization of the ureter. PMID: 32103621 [PubMed - as supplied by publisher]
AbstractDeeply infiltrative endometriosis (DIE) is a common gynecologic disease affecting women of reproductive age and often causing chronic pelvic pain and infertility. Clinical treatment options and preventive actions are ineffective due to the lack of knowledge about the etiology of DIE. Surgical treatment is currently the only alternative to eradicate the disease. Diagnostic imaging plays a crucial role for surgical planning and postoperative evaluation. Transvaginal sonography (TVS) with a dedicated protocol and magnetic resonance imaging (MRI) can be used to evaluate recurrent disease. Extensive pelvic surgery may c...
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.
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 supracerv...
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.