Laparoscopic ureterolysis and dissection of the paravesical space for deeply scarred adnexal masses

Abstract

Introduction: Laparoscopic ureterolysis is a delicate procedure that requires advanced laparoscopic skills.

Materials and methods: We are reporting two cases of laparoscopic hysterectomy and salpingo-oophorectomy with severe adhesions to the pelvic sidewall that required ureterolysis and describing a modified technique suitable for the laparoscopic performance of this procedure.

Results: In more than 15 years of doing laparoscopic ureterolysis to deal with various gynecological cases, we have never had a ureteral injury related to the ureterolysis procedure. There have been uterine artery lacerations, usually when trying to apply clips for uterine artery ligation in which case the artery can be compressed with a clamp until it is reclipped, bipolar-cauterized or suture-ligated using intracorporeal knot tying. However, we did not have a single patient that required open surgery because of these lacerations.

Conclusion: Because of the advantage of magnified viewing and laparoscopic dissection techniques which control small vessel bleeding, the laparoscopic route for ureterolysis is far easier to use than its open counterpart once it is learned. Laparoscopy, in addition, offers the added advantages of shorter hospital stay, reduced patient pain, reduced transfusion requirements and far better cosmetic results.