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Han Y, Liu P, Chen C, Duan H, Li W, Song W, Xu Y, Chen R, Tang L. Digital anatomic study of the ureter relative to bifurcation of the common iliac artery in females. MINIM INVASIV THER 2019; 30:101-105. [PMID: 31782331 DOI: 10.1080/13645706.2019.1692038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Laparoscopic salpingo-oophorectomy and pelvic lymphadenectomy place the ureter at risk. Although traditional anatomic studies indicate that ureters generally cross over the common iliac artery in the pelvic inlet, the view is often different during surgery. Hence, digital three-dimensional models have been utilized to solve this conundrum. Our study aimed to evaluate the anatomic relation between the iliac artery and the ureter in the pelvic inlet. MATERIAL AND METHODS A medical image processing system processed data collected from 129 female patients, and digital 3D models of the iliac artery and ureter were used to study their anatomic relation. Left- and right-side data were compared using Pearson's χ2 analysis. RESULTS Two different anatomic relations were found immediately posterior to the ureter: Common iliac arteries were present in 33.2% and external iliac arteries in 76.8%. The mean distances from the point at which the ureter crossed over the iliac artery until the bifurcation of the artery was 8.8 ± 12.2 mm in the left pelvis and 12.4 ± 10.8 mm in the right pelvis - different from that of the traditional anatomic study. CONCLUSION In the future, these models and digital anatomical data could help avoid surgical complications.
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Affiliation(s)
- Yan Han
- Department of Gynecology, The People's Hospital of Changzhi, Changzhi, China.,Department of Obstetrics and Gynecology, Nan Fang Hospital of Southern Medical University, Guangzhou, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nan Fang Hospital of Southern Medical University, Guangzhou, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nan Fang Hospital of Southern Medical University, Guangzhou, China
| | - Hui Duan
- Department of Obstetrics and Gynecology, Nan Fang Hospital of Southern Medical University, Guangzhou, China
| | - Weili Li
- Department of Obstetrics and Gynecology, Nan Fang Hospital of Southern Medical University, Guangzhou, China
| | - Wenxia Song
- Department of Gynecology, The People's Hospital of Changzhi, Changzhi, China
| | - Yikai Xu
- Department of Radiology, Nan Fang Hospital of Southern Medical University, Guangzhou, China
| | - Ruiying Chen
- Department of Radiology, Nan Fang Hospital of Southern Medical University, Guangzhou, China
| | - Lei Tang
- Department of Anatomy, Nan Fang Hospital of Southern Medical University, Guangzhou, China
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Kim E, Wu H, Simpson K, Patzkowsky K, Wang K. Litigations Involving Ureteral Injury Related to Minimally Invasive Gynecologic Surgery: Lessons Learned from a Legal Literature Review. J Minim Invasive Gynecol 2019; 26:608-617. [DOI: 10.1016/j.jmig.2018.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/26/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
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Cuss A, Bhatt M, Abbott J. Coming to terms with the fact that the evidence for laparoscopic entry is as good as it gets. J Minim Invasive Gynecol 2014; 22:332-41. [PMID: 25460522 DOI: 10.1016/j.jmig.2014.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/27/2014] [Accepted: 10/30/2014] [Indexed: 02/07/2023]
Abstract
Entry to the peritoneal cavity for laparoscopic surgery is associated with defined morbidity, with all entry techniques associated with substantial complications. Debate over the safest entry technique has raged over the last 2 decades, and yet, we are no closer to arriving at a scientifically valid conclusion regarding technique superiority. With hundreds of thousands of patients required to perform adequately powered studies, it is unlikely that appropriately powered comparative studies could be undertaken. This review examines the risk of complications related to laparoscopic entry, current statements from examining bodies around the world, and the medicolegal ramifications of laparoscopic entry complications. Because of the numbers required for any complications study, with regard to arriving at an evidence-based decision for laparoscopic entry, we ask: is the current literature perhaps as good as it gets?
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Affiliation(s)
- Amanda Cuss
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia
| | | | - Jason Abbott
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia.
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Shaw J, Tunitsky-Bitton E, Barber MD, Jelovsek JE. Ureterovaginal fistula: a case series. Int Urogynecol J 2013; 25:615-21. [DOI: 10.1007/s00192-013-2272-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/31/2013] [Indexed: 12/01/2022]
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Stan DL, Shuster LT, Wick MJ, Swanson CL, Pruthi S, Bakkum-Gamez JN. Challenging and complex decisions in the management of the BRCA mutation carrier. J Womens Health (Larchmt) 2013; 22:825-34. [PMID: 23987739 PMCID: PMC4047843 DOI: 10.1089/jwh.2013.4407] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Women afflicted by the hereditary breast and ovarian cancer syndrome face complex decisions regarding medical interventions aimed at reducing their risk of ovarian and breast cancer, interventions which in turn may interfere with their fertility and cause early menopause. This review addresses selected topics of importance and controversy in the management of the BRCA mutation carrier, such as psychological well-being and quality of life, breast and ovarian cancer screening, risk-reducing interventions for breast cancer and ovarian cancer, the issue of hysterectomy at the time of the risk-reducing salpingo-oophorectomy, health consequences of early surgical menopause, and safety of hormonal therapy after oophorectomy. The information presented is based on an extensive review of the literature on the selected topics and on the expertise of our multidisciplinary team.
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Affiliation(s)
- Daniela L. Stan
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Lynne T. Shuster
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Myra J. Wick
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Casey L. Swanson
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Sandhya Pruthi
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Yu S, Wu H, Xu L, Li G, Zhang Z. Early surgical repair of iatrogenic ureterovaginal fistula secondary to gynecologic surgery. Int J Gynaecol Obstet 2013; 123:135-8. [DOI: 10.1016/j.ijgo.2013.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 05/15/2013] [Accepted: 07/23/2013] [Indexed: 11/29/2022]
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Mild hydronephrosis after uncomplicated hysterectomy. Eur J Obstet Gynecol Reprod Biol 2013; 168:102-6. [PMID: 23351669 DOI: 10.1016/j.ejogrb.2012.12.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 12/06/2012] [Accepted: 12/29/2012] [Indexed: 11/22/2022]
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Affiliation(s)
- Michael Baggish
- The Women's Center, Saint Helena Hospital, Saint Helena, CA
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, Cincinnati, OH (emeritus)
- Department of Obstetrics and Gynecology, University of California, San Francisco, San Francisco, CA
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AAGL Practice Report: Practice Guidelines for Intraoperative Cystoscopy in Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2012; 19:407-11. [DOI: 10.1016/j.jmig.2012.05.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 05/02/2012] [Indexed: 11/30/2022]
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Janssen PF, Brölmann HAM, van Kesteren PJM, Bongers MY, Thurkow AL, Heymans MW, Huirne JAF. Perioperative outcomes using LigaSure™ compared to conventional bipolar instruments in laparoscopic salpingo-oophorectomy: a randomized controlled trial. Surg Endosc 2012; 26:2884-91. [PMID: 22538682 DOI: 10.1007/s00464-012-2274-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 03/23/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of this study was to compare the effects of LigaSure™ versus conventional bipolar techniques on operating time and blood loss during laparoscopic salpingo-oophorectomy in a randomized controlled trial. METHODS In three teaching hospitals, 100 women undergoing a laparoscopic salpingo-oophorectomy were randomized for LigaSure or conventional bipolar instruments. Primary outcome was operating time (from initial skin incision to removal of the specimen). Secondary outcome measures were total operating time (from initial skin incision to skin closure), time to dissect the ovarian and infundibulopelvic ligaments, intraoperative blood loss, and subjective judgment of the instrument used. RESULTS There were no differences in operating time and total operating time using LigaSure versus conventional bipolar instruments: 41.0 vs. 39.2 min (p = 0.78; 95 % CI = -10.9 to 14.5) and 54.6 vs. 58.6 min (p = 0.46; 95 % CI = -14.8 to 6.8), respectively. The mean blood loss using LigaSure versus conventional bipolar instruments was 38 vs. 33 mL (p = 0.73; 95 % CI = -22.7 to 32.2). Various subjective efficacy and instrument handling parameters of the two instruments varied among participating centers. CONCLUSION There were no significant differences in operating time and blood loss with the use of LigaSure compared to conventional bipolar instruments during laparoscopic salpingo-oophorectomy, even after correction for potential confounders.
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Affiliation(s)
- Petra F Janssen
- Department of Obstetrics and Gynecology, VU University Medical Center, De Boelelaan 1117, 1181 HV, Amsterdam, The Netherlands.
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Baggish MS. Urinary Tract Injuries Secondary to Gynecologic Laparoscopic Surgery: Analysis of 75 Cases. J Gynecol Surg 2010. [DOI: 10.1089/gyn.2010.0019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael S. Baggish
- Department of Obstetrics and Gynecology, Good Samaritan Hospital, and University of Cincinnati, College of Medicine, Cincinnati, OH
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Lim MC, Lee BY, Lee DO, Joung JY, Kang S, Seo SS, Chung J, Park SY. Lower urinary tract injuries diagnosed after hysterectomy: Seven-year experience at a cancer hospital. J Obstet Gynaecol Res 2010; 36:318-25. [DOI: 10.1111/j.1447-0756.2009.01153.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE To estimate the incidence and location of injury to the urinary tract during hysterectomy for benign gynecologic disease. METHODS This was a prospective clinical study in an academic environment performed at three sites. Diagnostic cystourethroscopy was performed on all patients after hysterectomy for benign disease. RESULTS Eight hundred thirty-nine patients were enrolled. The incidence of urinary tract injury associated with hysterectomy for benign disease was 4.3% (39 of 839 cases). The rate of bladder injury was 2.9% (24 of 839 cases), and rate of ureteral injury was 1.8% (15 of 839 cases). There were three cases of simultaneous bladder and ureteral injuries, resulting in a cumulative injury rate of 4.3%. The injury detection rate using intraoperative diagnostic cystoscopy was 97.4% (817 of 839 cases). The most common site of injury to the ureter was at the junction of the ureter and the uterine artery in 80% (12 of 15 cases) of ureteral injuries. Transection and kinking injuries were the most frequent type of injury. There were 21 cases of subnormal dye efflux from the ureteral orifices, with no subsequent injury detected on further evaluation. CONCLUSION Ureteral injury occurred most commonly at the level of the uterine artery, and transection and kinking injuries were most frequent. Diminished dye efflux from ureteral orifices was not associated with injury. LEVEL OF EVIDENCE III.
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Tanaka Y, Asada H, Kuji N, Yoshimura Y. Ureteral catheter placement for prevention of ureteral injury during laparoscopic hysterectomy. J Obstet Gynaecol Res 2008; 34:67-72. [PMID: 18226132 DOI: 10.1111/j.1447-0756.2007.00686.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Ureteral injury is among the most devastating complications of gynecologic surgery. Estimated incidence of ureteral injury during laparoscopic hysterectomy is 2.6-35 times (0.2-6.0%) that in abdominal hysterectomy. We investigated preoperative ureteral catheter (UC) placement as a way to prevent ureteral injury in laparoscopic hysterectomy. METHODS Clinical records of 94 women who underwent laparoscopic hysterectomy between February 2006 and January 2007 in Yazaki Hospital, Kanagawa, Japan, were reviewed retrospectively. Thirty-four patients between February and June 2006 underwent the surgery without ureteral catheterization and 60 patients between July 2006 and January 2007 underwent surgery with ureteral catheterization. Clinical outcomes were statistically compared between the two groups. RESULTS The average time required for catheter insertion was 9.35 min. The ureter in which the catheter was placed was visualized clearly. In one patient, whose left ureter was deviated by a massive myoma, catheter insertion was not possible. No complications arose from catheter placement except for minor complaints including low back pain, urinary discomfort, and transient hematuria. While one injury occurred in a patient without ureteral catheterization (1/34), no ureteral injury occurred in any patient with ureteral catheterization (0/60). Operative time, total blood loss, and hospital stay were not significantly different between the two groups. CONCLUSIONS UC placement is simple, helping to prevent ureteral injury during laparoscopic hysterectomy and enhancing safety of this procedure.
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Affiliation(s)
- Yudai Tanaka
- Department of Obstetrics and Gynecology, Yazaki Hospital, Kanagawa, Japan.
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A diagnostically challenging case of ureterovaginal fistula after laparoscopic hysterectomy. J Minim Invasive Gynecol 2008; 15:209-11. [PMID: 18312993 DOI: 10.1016/j.jmig.2007.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 09/13/2007] [Accepted: 09/15/2007] [Indexed: 11/21/2022]
Abstract
A complicated case of iatrogenic ureterovaginal fistula in a 56-year-old woman after laparoscopic-assisted vaginal hysterectomy, which persisted after several attempts of repair including ureterocystoneostomy, is presented. Accurate radiologic work-up enabled us to identify a refluxing ureteral stump, which was not ligated at the time of ureterocystoneostomy, as the origin of urinary leakage. Surgical principles that should be adhered to when managing such complex cases to obtain successful long-lasting outcome are described.
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De Cicco C, Ret Dávalos ML, Van Cleynenbreugel B, Verguts J, Koninckx PR. Iatrogenic ureteral lesions and repair: a review for gynecologists. J Minim Invasive Gynecol 2007; 14:428-35. [PMID: 17630159 DOI: 10.1016/j.jmig.2007.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 12/27/2006] [Accepted: 01/07/2007] [Indexed: 10/23/2022]
Abstract
Ureter injuries are a well-known complication of gynecologic surgery and a frequent cause of medicolegal problems. Because there are no randomized, controlled trials and the available studies are small series and case reports, the evidence on which to base treatment is weak. We therefore reviewed the complete English-language literature of ureter repair since 1990. In total, 608 ureter injuries were reported. Although it is widely believed that for laceration or section the prognosis is affected by a delay in diagnosis, we could not find evidence to substantiate this. An obstruction requires stenting only. For a laceration, stenting with suturing was more effective than stenting only (p = .006). A ureter anastomosis was successful in over 94% of cases either by laparotomy or laparoscopy. In conclusion, the literature data are scanty and heterogeneous and do not permit solid conclusions. Evidence, however, is emerging that a laceration should be treated by stenting and suturing. A ureter anastomosis over a stent could become a valid option especially when performed by laparoscopy.
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Affiliation(s)
- Carlo De Cicco
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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Narang V, Sinha T, Karan SC, Sandhu AS, Sethi GS, Srivastava A, Talwar R, Adlakha N. Ureteroscopy: Savior to the gynecologist?—Ureteroscopic management of post laparoscopic-assisted vaginal hysterectomy ureterovaginal fistulas. J Minim Invasive Gynecol 2007; 14:345-7. [PMID: 17478367 DOI: 10.1016/j.jmig.2006.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Revised: 10/11/2006] [Accepted: 10/13/2006] [Indexed: 10/23/2022]
Abstract
Iatrogenic ureteral injuries are among the most serious complications in gynecologic surgery. With the increasing popularity of laparoscopic gynecologic surgery, the incidence of ureteral injuries is on the rise. We report 2 cases of post laparoscopic-assisted vaginal hysterectomy (post LAVH) ureterovaginal fistulas, which were managed successfully with retrograde stenting using ureteroscopy. Three middle-aged women who underwent LAVH for symptomatic myomas of the uterus presented with ureterovaginal fistulas in the late postoperative period. Excretory urography revealed ureterovaginal fistulas involving the distal ureter. Retrograde stenting was possible in 2 patients, using a 7.5F rigid ureteroscope. Both patients became continent 2 days after surgery. Urography at 6 weeks revealed normal renal function without obstruction or extravasation of urine, and the stents were removed. Stenting failed in the third patient; the patient underwent a ureteric reimplantation successfully. Post LAVH ureterovaginal fistulas are amenable to ureteroscopic retrograde double-J stenting, which enables spontaneous recovery of the injured ureter. An attempt of ureteroscopic stenting should be considered in all patients with post LAVH ureterovaginal fistulas before subjecting them to other modalities.
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Affiliation(s)
- Vineet Narang
- Department of Urology, Army Hospital, Delhi Cantt, Delhi, India.
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Wu HH, Yang PY, Yeh GP, Chou PH, Hsu JC, Lin KC. The detection of ureteral injuries after hysterectomy. J Minim Invasive Gynecol 2006; 13:403-8. [PMID: 16962522 DOI: 10.1016/j.jmig.2006.04.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Revised: 04/20/2006] [Accepted: 04/21/2006] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To identify the incidence and outcomes of ureteral injuries in patients undergoing hysterectomy, and to evaluate the effect of intraoperative cystoscopy and early postoperative ureteral jet ultrasonography. DESIGN Retrospective comparative study (Canadian Task Force classification II-2). SETTING Tertiary medical center. PATIENTS Fifteen patients who experienced ureteral injuries while undergoing hysterectomy out of 4950 total patients during a 6-year period. INTERVENTIONS All patients underwent hysterectomy, and intraoperative cystoscopy or early postoperative ureteral jet ultrasonography were used to evaluate ureteral integrity. MEASUREMENTS AND MAIN RESULTS The incidence of ureteral injury recognized after hysterectomy was 0.32%, and all ureteral injuries occurred during laparoscopic hysterectomy. The initial detection of ureteral injury resulted from intraoperative cystoscopy in five patients, early postoperative ureteral jet ultrasonography in two patients, and signs and symptoms in eight patients. The patients whose injuries were detected by either intraoperative cystoscopy or early postoperative ureteral jet ultrasonography were diagnosed earlier (1.7 and 19.9 postoperative days, respectively; p<.01) and tended toward more conservative treatment (p=.119; OR=10; 95% CI 0.78-128.78) than those who were diagnosed based on signs and symptoms alone. CONCLUSIONS Use of intraoperative cystoscopy or early postoperative ureteral jet ultrasonography leads to earlier diagnosis of posthysterectomy ureteral injury, thereby allowing for more conservative treatment.
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Affiliation(s)
- Hsin-Hung Wu
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, and College of Health Sciences, Institute of Medical Research, Chang Jung Christian University, Tainan, Taiwan.
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Abstract
The most common cause of iatrogenic injuries to the ureter (75%) is a gynecological or surgical pelvic procedure. The diagnosis of ureteral injuries is delayed in 66% (after days or weeks). Lack of hematuria is an unreliable sign to exclude injury, since 30% of all ureteral injuries do not even demonstrate microscopic hematuria or classic clinical symptoms and signs. In view of this, the diagnosis must be one of suspicion and further evaluations are mandatory in all cases of penetrating or blunt abdominal injuries. The most accurate diagnostic tools are CT scan with delayed excretory images and retrograde ureterography, which can also be used to guide stent placement. Low-grade injuries can be sufficiently treated with urinary diversion by PCN drainage or endoscopic ureteric stenting. The treatment of high-grade injuries depends on the localization and extent of the damage. The principles of repair include débridement, spatulation, lack of tension, stenting, postoperative drainage, and a watertight anastomosis with fine nonreactive absorbable suture. A delay in diagnosis is the most important factor contributing to the morbidity of ureteric injuries, and early treatment can reduce the complication rate to below 5%.
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Affiliation(s)
- D Teber
- Urologische Klinik, Akademisches Lehrkrankenhaus Universität Heidelberg, SLK-Kliniken, Heilbronn.
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Brandes S, Coburn M, Armenakas N, McAninch J. Diagnosis and management of ureteric injury: an evidence-based analysis. BJU Int 2004; 94:277-89. [PMID: 15291852 DOI: 10.1111/j.1464-410x.2004.04978.x] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Steven Brandes
- Department of Surgery (Urology), School of Medicine, Washington University Medical Center, 4960 Children's Place, St. Louis, MO 63110, USA.
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Koh LW, Koh PH, Lin LC, Ng WJY, Wong E, Huang MH. A Simple Procedure for the Prevention of Ureteral Injury in Laparoscopic-Assisted Vaginal Hysterectomy. ACTA ACUST UNITED AC 2004; 11:167-9. [PMID: 15200768 DOI: 10.1016/s1074-3804(05)60192-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To introduce a surgical technique to minimize the chance of ureteral injury during laparoscopic-assisted vaginal hysterectomy (LAVH). DESIGN Retrospective case review (Canadian Task Force classification II-3). SETTING Show Chwan Memorial Hospital, Changhua, Taiwan. PATIENTS Two thousand and six women who underwent LAVH between January 1992 and June 2001. INTERVENTION A simple step of creating a "window" over the anterior and posterior broad ligaments to push inferolaterally the areolar tissue (in which the ureter is embedded) on the posterior broad ligament. MEASUREMENTS AND MAIN RESULTS No ureteral injury occurred in patients whose cases were reviewed. There were, however, five bladder injuries (0.25%) and three nerve pareses (0.15%). Other minor complications, including fever, abscess or hematoma of the vaginal cuff, subcutaneous emphysema, and delayed vaginal cuff bleeding, occurred in less than 5% of patients. CONCLUSION The technique proposed is simple and very effective in preventing ureteral injury during LAVH.
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Affiliation(s)
- Lim-Woh Koh
- Department of Obstetrics and Gynecology, Show Chwan Memorial Hospital, Changhua, Taiwan
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Dandolu V, Mathai E, Chatwani A, Harmanli O, Pontari M, Hernandez E. Accuracy of cystoscopy in the diagnosis of ureteral injury in benign gynecologic surgery. Int Urogynecol J 2003; 14:427-31. [PMID: 14677006 DOI: 10.1007/s00192-003-1095-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2003] [Accepted: 09/13/2003] [Indexed: 10/26/2022]
Abstract
Our objective was to review our experience and attempt to identify risk factors for ureteral injury during gynecologic surgery for benign conditions. A retrospective chart review was performed of all cases of ureteral injury during gynecologic surgery for benign conditions, at Temple University Hospital, from January 1992 to September 2002. We analyzed hospital records to determine whether the injury was diagnosed intraoperatively, with postprocedure cystoscopy, or if cystoscopy was ineffective in diagnosing the injury. There were nine ureteral injuries during the study period. Of these, two were diagnosed during the procedure, two were discovered by immediate postprocedure cystoscopy, and the other five were discovered during the postoperative period. Of these five, three patients had immediate postprocedure cystoscopy and the injuries were not detected. Risk factors associated with ureteral injury included: a large uterus (5), high-grade cystocele (3), ectopic insertion of the ureter into the bladder (1), and previous surgeries (4). Our conclusion was that negative cystoscopy cannot be solely relied on to rule out ureteral injury, as cases with partial obstruction and ureteral patency can be missed.
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Affiliation(s)
- Vani Dandolu
- Depertment of Obstetrics and Gynecology, Division of Urogynecology, Temple University Hospital, 3401 N Broad Street, Seventh floor, Outpatient Building, PA 19140, Philadelphia, USA.
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Abstract
No matter how skilled the surgeon, the risk of complications always exists. Complications of laparoscopic surgery include anesthesia difficulties, positioning and nerve injuries, injuries due to insertion of needles and trocars, and intraoperative vascular, bowel, and urinary tract injuries. Injuries from electrosurgical equipment may also result. This article focuses on preventing such complications.
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Affiliation(s)
- Ralph Philosophe
- The Foxboro Center for Women's & Family Health, Foxboro, MA 02035, USA.
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Kives SL, Levy BS, Levine RL. Laparoscopic-assisted vaginal hysterectomy: American Association of Gynecologic Laparoscopists' 2000 membership survey. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2003; 10:135-8. [PMID: 12732759 DOI: 10.1016/s1074-3804(05)60286-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Erian MMS, Goh JTW, Coglan M. Auditing complications of laparoscopy in a major tertiary hospital in Australia. ACTA ACUST UNITED AC 2002. [DOI: 10.1046/j.1365-2508.2001.00450.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Terzibachian JJ, Gay C, Bertrand V, Bouvard M, Knoepffler F. [Value of ureteral catheterization in laparoscopy]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2001; 29:427-32. [PMID: 11462958 DOI: 10.1016/s1297-9589(01)00156-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Describe indications and procedures of ureteral retrograde catheter placement in operative laparoscopy. Assess the security that allows this technique to avoid or detect ureteral injury. STUDY DESIGN A cohort study over a five year period was performed on 1722 patients who underwent an operative gynecologic laparoscopy. SURGICAL TECHNIQUE When presumptive evidence of ureter adhesiolysis (dense adhesions from previous surgery, endometriosis), or suspicion of iatrogenic ureter transection, laparoscopic procedure was interrupted. A cystoscopy was performed and an internalized stent was inserted. RESULTS In nine cases (preventive indications), patients required this procedure in adnexal surgery (dense adhesions from previous operations endometriosis), in oophorectomy for residual ovary syndrome and ovarian remnant syndrome and in hysterectomy with an intraligamentary leiomyomata. In one case (diagnostic indication), ureteral catheter placement was performed after use of an endoscopic linear stapler during a laparoscopically assisted vaginal hysterectomy. CONCLUSION This intra-operative procedure can allow better ureter recognition and its safe dissection when complex operative laparoscopy is foreseen.
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Affiliation(s)
- J J Terzibachian
- Service de chirurgie gynécologique, centre hospitalier de Belfort, 14, rue de Mulhouse, 90016 Belfort, France
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Nouira Y, Oueslati H, Reziga H, Horchani A. Ureterovaginal fistulas complicating laparoscopic hysterectomy: a report of two cases. Eur J Obstet Gynecol Reprod Biol 2001; 96:132-4. [PMID: 11311780 DOI: 10.1016/s0301-2115(00)00391-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Three ureterovaginal fistulas occurred following laparoscopic hysterectomy in two patients. Inadvertent burn of the distal ureter by a unipolar electrocautery was thought to be the cause. Avoidance of unipolar cautery to achieve hemostasis of uterine arteries would have prevented these urologic complications.
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Affiliation(s)
- Y Nouira
- Department of Urology, La Rabta Hospital, 1002, Tunis, Tunisia
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Hung MJ, Huang CH, Chou MM, Liu FS, Ho ES. Ultrasonic diagnosis of ureteral injury after laparoscopically-assisted vaginal hysterectomy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2000; 16:279-283. [PMID: 11169298 DOI: 10.1046/j.1469-0705.2000.00219.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Ureteral injuries are uncommon but serious complications of laparoscopically-assisted vaginal hysterectomy. The ureter is particularly at risk for inadvertent injury when the cardinal-uterosacral ligament complex is coagulated and divided below the uterine vessels. We present two recent cases which describe the application of transabdominal ultrasound including color Doppler mapping in the diagnosis of ureteral injury after laparoscopically-assisted vaginal hysterectomy. Transabdominal ultrasound including color Doppler mapping has great diagnostic potential as a method for non-invasive evaluation of post-operative ureteral conditions. Ultrasonic triads (absence of a ureteric jet, ascites, and the presence or absence of hydronephrosis) are capable of differentiating diagnosis of complete, partial, or nonobstructive surgical ureteral injuries.
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Affiliation(s)
- M J Hung
- Department of Obstetrics & Gynecology, Taichung Veterans General Hospital, no. 160, Taichung Harbor Road, Section 3, Taichung, Taiwan, Republic of China
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Abstract
Ovarian cancer usually remains clinically silent until it is far advanced, and is associated with significant morbidity and mortality. In view of the modest impact of adjuvant treatments on survival, much effort is devoted to early detection programs and prevention strategies. However, the usefulness of early detection programs remains to be established, with only one randomized study indicating improved median survival in screened individuals. At present, oral contraceptives and prophylactic oophorectomy are the only options for prevention of ovarian cancer. Indications for prophylactic oophorectomy either as a primary procedure, or secondary to abdominal surgery, will vary according to the estimated risk, and to the individual's perception of that risk. Genetic screening allows better identification of pre-symptomatic individuals who would benefit the most from prophylactic oophorectomy. Data concerning the benefit of prophylactic surgery, and the safety of established or innovative hormone replacement therapies in individuals at risk, are encouraging.
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Affiliation(s)
- W H Gotlieb
- Division of Gynecologic Oncology and the Suzanne Levy Gertner Oncogenetics Unit, Sheba Medical Center, Tel Hashomer, Israel.
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Meltomaa SS, Taalikka MO, Helenius HY, Mäkinen JI. Complications and long-term outcomes after adnexal surgery by laparotomy and laparoscopy. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1999; 6:463-9. [PMID: 10548706 DOI: 10.1016/s1074-3804(99)80012-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To assess complications and subjective outcomes after adnexal surgery by laparotomy and laparoscopy. DESIGN Observational study (Canadian Task Force classification II-2). SETTING University-affiliated hospital. PATIENTS Two-hundred twenty-eight women requiring adnexal surgery for benign indications. INTERVENTIONS The 114 patients who underwent laparotomy and 114 having laparoscopy were followed prospectively for 1 year. Two questionnaire-based evaluations were undertaken to determine subjective outcomes. To evaluate possible later surgical procedures, hospital records were reviewed 4 years after operation. MEASUREMENTS AND MAIN RESULTS No major complications occurred in the laparotomy group. The two (1.8%) in the laparoscopy group were intestinal injury and aortal injury, both in women who had previously undergone laparotomy. Rates of minor complications were 11.4% for laparotomy and 7.0% for laparoscopy. Two patients in both groups were readmitted. No difference was found between groups in need for additional adnexal procedures up to 4 years after operation. After 1 year, frequencies of subjective complaints and satisfaction with surgical procedure did not differ significantly. Mean hospital cost per patient was less for laparoscopy than for laparotomy. CONCLUSION No statistically significant differences were seen after adnexal surgery by laparoscopy and laparotomy with regard to frequency of complications and subjective outcomes. Laparoscopy in women who have previously undergone laparotomy may be associated with a slightly greater risk of major complications than another laparotomy.
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Affiliation(s)
- S S Meltomaa
- Departments of Obstetrics and Gynecology, University of Turku, Finland
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Abstract
Lesions of the urinary tract being a rare, but typical, complication of gynaecological surgery need a skilled pelvic surgeon for prevention and, when they occur, knowledge of adequate techniques of repair or palliative solutions until final repair can take place. The increasing incidence of lesions of the urinary tract as a result of endoscopic surgery makes better training mandatory.
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Affiliation(s)
- E Petri
- School of Obstetrics and Gynecology, University of Rostock, Schwerin Medical Center, Germany.
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