Page 57 - World Association of Laparoscopic Surgeons - Journal

10.5005/jp-journals-10007-1147
Gina Sternschuss
REVIEW ARTICLE
Ureteral Injury in Gynecologic Laparoscopy

Gina Sternschuss

ABSTRACT Urological injury can also be the basis of medicolegal
suits.
Purpose: To review incidence, presentation, diagnostic
methods, management, significance and avoidance of ureteral It is an important concern for gynecologists, and can
injuries in gynecologic laparoscopy. happen to inexperienced as well as to experienced
Materials and methods: PubMed, National Center for gynecologic surgeons. Awareness, as well as early
Biotechnology Information Database, Journal of the Society of recognition and detection of the possibility of urologic injury
Laparoendoscopic Surgeons, obstetrics and gynecology journal, is paramount of safe gynecologic laparoscopic surgery. 5
google images were reviewed to gather information regarding Most common sites of ureteric injury during gynecologic
ureteral injuries in gynecologic laparoscopy.
laparoscopy are at the level of pelvic brim, near the
Results: Ureteral injury is one of the serious complications of
infundibulopelvic ligament, and at the level where the ureter
laparoscopic surgery, in particular, gynecologic laparoscopy. It
passes beneath uterine artery.
is very important to be familiar with presentation, diagnostic
methods and management as well as prevention of ureteral Factors associated with increased incidence of ureteric
injury at the time of gynecologic laparoscopy. injury are the conditions leading to the distortion of the
Conclusion: Every gynecologic surgeon has to be familiar with pelvic anatomy, such as extensive endometriosis, pelvic
signs and symptoms as well as management of ureteral injury adhesions, presence of large pelvic mass. 5
at the time of gynecologic laparoscopy. Noteworthy that almost half of ureteric injuries occurring
Keywords: Gynecologic laparoscopy, Ureteral injury, Ureteral during laparoscopic hysterectomy, occur during simple,
stenting. uncomplicated hysterectomy. 6 Some investigators found
that ureteral injury during laparoscopy most commonly
How to cite this article: Sternschuss G. Ureteral Injury in 7
Gynecologic Laparoscopy. World J Lap Surg 2012;5(1): occurs near the uterosacral ligaments.
46-48. Some surgeons routinely dissect the ureter, exposing its
course retroperitoneally, although it is also not without
Source of support: Nil
drawbacks, such as risk of injury to the major vessels on
Conflict of interest: None declared
the pelvic sidewall. Some surgeons routinely stent the
ureters, but stenting the ureters has not been shown to
INTRODUCTION
decrease the risk of ureteral injury (Fig. 1). In fact, presence
Laparoscopic gynecologic surgeries have a clear
advantage over open surgeries and considered to be more
beneficial for the patients since patients undergoing
laparoscopic gynecologic surgeries return to normal
activities quicker, have shorter hospitalizations, fewer
infections, lower overall blood loss and less postoperative
pain. 1 Laparoscopic procedures are generally safe,
effective and well tolerated by the patients. 2 But, e.g.
laparoscopic-assisted vaginal hysterectomy from lap hyst
paper has higher risk of bladder and ureter injury than
3
abdominal hysterectomy. Overall rate of lower urinary
tract injury during gynecologic laparoscopy is 3 to 4%. 4
Injury to the lower urinary tract leads to increase in
patient’s morbidity and mortality as well as decrease in
quality of life.
Urological injury is a very serious complication in
gynecological laparoscopic operations. It is associated with
the morbidity of vesicovaginal fistula, ureteric stenosis as
well as hydronephrosis with variable degrees of renal
impairment and failure may occur. Fig. 1: Ureteral stenting 14

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