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WJOLS

Prophylactic Ureteric Catheterization with Illuminated Ureteric Stent during Difficult Laparoscopic Colorectal Surgeries

Some surgeons advocate that this practice of indications being the inflammatory bowel diseases, previous
preoperative placement of ureteric stents should help avoid abdominal or pelvic surgeries, previous exposure to
ureteric injury, 1,3,4 while others fear the potential injury radiation, obesity and colorectal malignancies. Due to the
during insertion and postoperative urinary complications intraoperative identification of ureters, the iatrogenic injury
including oliguria, anuria and urinary tract infection. due to surgery and also the conversion rate to laparotomies
Moreover, the insertion of preoperative ureteric catheters is also minimized. Hence, use of prophylactic illuminated
increases both the length of time in the operating room and ureteric catheters is justified.
that under anesthesia as well as the overall cost of the
procedure. REFERENCES
Ureteric stents can be of great help, if ureter 1. Tsujinaka S, Wexner SD, Dasilva G, Sands DR. Prophylactic
5
identification difficulty is anticipated. Standard 5F stents ureteric caterters in laparoscopic colorectal surgery. Tech
Coloproctol 2008;12:45-50.
placement at the beginning of surgery allows easy 2. Agachan F, Joo JS, Weiss EG, Wexner SD. Intraoperative
identification by palpation. However, this is not 100% laparoscopic complications. Dis Colon and Rectum 1996;39:
reliable. The use of illuminated ureteric stents adds another S14-19.
dimension to ensuring ureteric safety in complex cases by 3. Bothwell WN, Bleicher RJ, Dent TL. Prophylactic ureteral
giving direct visualization of the ureteric position throughout catheterization in colon surgery. Dis Colon Rectum 1994;37:
330-34.
6
the dissection. Ureteric catheters may be particularly useful 4. Kyzer S, Gordon PH. The prophylactic use of ureteral catheters
during laparoscopic colorectal procedures in which tactile during colorectal operations. Am Surg 1994;60:212-26.
localization is difficult. 5. Nam YS, Steven D, Wexner. Clinical value of prophylactic
Intraoperative complications have included laceration ureteral stent indwelling during laparoscopic colorectal surgery.
J Korean Med Sci 2002;17:633-35.
7
or perforation of the ureter during the stent placement. Well 6. Phipps JH, Tyrell NJ. Transilluminating ureteric stents for
et al noted a 2.2% intraoperative complication rate in 561 preventing operative ureteric damage. Br J Obstet Gynaecol
prophylactic ureteric catheterizations, similar to the 2% rate 1992;99:81.
8
reported by Leff et al. No iatrogenic injury to ureters were 7. Sheikh FA, Khubchandani IT. Prophylactic ureteric catheters
observed in our study. in colon surgery—how safe are they? Report of three cases.
Dis Colon Rectum 1990;33:508-10.
Pandya et al investigated the conversions in 200 8. Leff EL, Groff W, Rubin RJ, Eisenstat TE, Salavati EP. Use of
laparoscopic colorectal surgeries to laparotomies in 47 of ureteral catheters in colonic and rectal surgery. Dis Colon
them for which the indication was nonidentification of Rectum 1982;25:457-60.
9
ureters. In another study by Huscher et al there were 21 9. Pandya S, Murray JJ, Coller JA, Rusin LC. Laparoscopic
colectomy: Indications of conversion to laparotomy. Arch Surg
conversions out of 200 for nonvisualization of ureters. 1999;134:471-75.
In our study, since the ureters were identified in all the
patients there was no conversion of laparoscopic surgery to ABOUT THE AUTHORS
laparotomy. So, this is an advantage in reducing the number
of conversions. Manash Ranjan Sahoo (Corresponding Author)
Associate Professor, Department of Surgery, SCB Medical College
CONCLUSION Cuttack, Odisha, India, Phone: 06712414034, 09937025779
e-mail: manash67@gmail.com
To conclude, prophylactic placement of illuminated ureteric
catheters can be of great help in identifying the ureters T Anil Kumar
especially in difficult colorectal surgeries and can be Postgraduate Student, Department of Surgery, SCB Medical College
3,4
performed with minimal morbidity to the patient. The Cuttack, Odisha, India

World Journal of Laparoscopic Surgery, September-December 2012;5(3):113-115 115