Laparoscopic ureteroplasty for accidental partial ureteral burn during total hysterectomy

The identification of the ureters in some laparoscopic procedures is mandatory and is done by dissection. However, the dissection must not be regarded as a means to avoid ureteral lesions. One must always remember that after dissecting the ureters, they are no longer at their anatomical position. They will be displaced medially. This video shows a ureteral partial section after ureteral dissection during a laparoscopic Wertheim procedure. The repair of this lesions is also shown.

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Laparoscopic ureteroplasty for accidental partial ureteral burn during total hysterectomy

Authors

A Wattiez, J Nassif, I Miranda-Mendoza

Abstract

The identification of the ureters in some laparoscopic procedures is mandatory and is done by dissection. However, the dissection must not be regarded as a means to avoid ureteral lesions. One must always remember that after dissecting the ureters, they are no longer at their anatomical position. They will be displaced medially. This video shows a ureteral partial section after ureteral dissection during a laparoscopic Wertheim procedure. The repair of this lesions is also shown.

Classification

tips and tricks

Keywords

Laparoscopy, ureteroplasty, accidental partial ureteral burn during total hysterectomy, Wertheim's procedure, radical hysterectomy

Media type

Surgical video

Duration

04'00''

Publication

2009-02

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E-publication

WeBSurg.com, Feb 2009;9(02).
URL: http://www.websurg.com/doi-vd01en2478.htm

Laparoscopic ureteroplasty for accidental partial ureteral burn during total hysterectomy

1. Introduction 00'18''

Ureters should always be dissected in major gynecologic surgeries such as endometriosis and gynecologic oncological surgeries. However, after dissecting ureters, one should pay attention to avoid thermal injury and mechanical injury (i.e., cutting ureters) after dissecting them.

2. Mechanism of ureteral injury 00'44''

The left ureter has a partial circumferential burn. The treatment of this condition consists of stenting the ureter with a double-J catheter, debriding the burned edges and suturing the ureter in order to approximate the defect.

3. Placing the ureteral stent 01'22''

Placing the ureteral stent under cystoscopic control and laparoscopic guidance renders the suturing process easier.

4. Ureteroplasty 02'00''

The suture used during ureteroplasty is an absorbable 4/0 material (i.e. Vicryl or Monocryl). And the stent is left in place, given that this patient may have eventual radiation therapy.