K F Tamussino1, P F Lang, E Breinl. 1. Department of Obstetrics and Gynecology, University of Graz, Austria. tamussino@adis.at
Abstract
OBJECTIVE: The study assessed the incidence, diagnosis, management, and causes of ureteral injuries during major laparoscopic operations at our department in a 6-year period. STUDY DESIGN: The study was a chart review of 790 consecutive major laparoscopic procedures in 711 patients (mean age 37.4 +/- 11.6 years, mean weight 64.3 +/- 29.1 kg). RESULTS: There were four ureteral complications in three patients during or after laparoscopic operations: three of 711 patients (0.42%) and four of 790 procedures (0.38%). All three ureteral complications (one transection and a total of three ureterovaginal fistulas in two patients) occurred during laparoscopically assisted vaginal hysterectomies, for an incidence of 4.3%. There were no ureteral injuries in 291 salpingo-oophorectomies, 414 ovarian cystectomies, and 15 colposuspensions. Both delayed ureteral complications occurred in the lower segment of the ureter after laparoscopic bipolar coagulation and division of the cardinal ligament. CONCLUSION: We conclude that in laparoscopic surgery the ureter is most at risk when the cardinal ligament is dissected and divided below the uterine vessels.
OBJECTIVE: The study assessed the incidence, diagnosis, management, and causes of ureteral injuries during major laparoscopic operations at our department in a 6-year period. STUDY DESIGN: The study was a chart review of 790 consecutive major laparoscopic procedures in 711 patients (mean age 37.4 +/- 11.6 years, mean weight 64.3 +/- 29.1 kg). RESULTS: There were four ureteral complications in three patients during or after laparoscopic operations: three of 711 patients (0.42%) and four of 790 procedures (0.38%). All three ureteral complications (one transection and a total of three ureterovaginal fistulas in two patients) occurred during laparoscopically assisted vaginal hysterectomies, for an incidence of 4.3%. There were no ureteral injuries in 291 salpingo-oophorectomies, 414 ovarian cystectomies, and 15 colposuspensions. Both delayed ureteral complications occurred in the lower segment of the ureter after laparoscopic bipolar coagulation and division of the cardinal ligament. CONCLUSION: We conclude that in laparoscopic surgery the ureter is most at risk when the cardinal ligament is dissected and divided below the uterine vessels.
Authors: Petra F Janssen; Hans A M Brölmann; Paul J M van Kesteren; Marlies Y Bongers; Andreas L Thurkow; Martijn W Heymans; Judith A F Huirne Journal: Surg Endosc Date: 2012-04-27 Impact factor: 4.584