Ureteral injury in laparoscopic gynecologic surgery

Abstract

The introduction of laparoscopy to gynecologic surgery has allowed for both innovative advancements and new challenges in the field. As the complexity of laparoscopically approached gynecologic cases continues to increase, it is imperative for surgeons to be aware of the risk of ureteral injury. Although rare, ureteral complications with gynecologic surgery may be quite morbid; therefore, knowledge about their prevention, diagnosis, and management is of the utmost importance.

Keywords: Hysterectomy; Intraoperative cystoscopy; Laparoscopy; Ureteral injury.

Figure 1

The ureter descends over the pelvic brim as it courses over the iliac vessels at the bifurcation of the common iliac artery into the external and internal iliac arteries.

Figure 2

In cases of laparoscopic adnexectomy, the ureter can be identified transperitoneally as it courses over the pelvic brim.

Figure 3

Some surgeons prefer to use upward traction on the uterine specimen with a laparoscopic tenaculum in lieu of a uterine manipulator. Either approach will ensure the distance from the ureter to the ascending uterine artery is increased substantially and the vascular pedicle can be safely controlled. increased substantially and the vascular pedicle can be safely controlled.