Ureteral complications with operative gynecologic laparoscopy

• Published in: American journal of obstetrics and gynecology Vol. 178; no. 5; pp. 967 - 970
• Main Authors: Tamussino, Karl F., Lang, Peter F.J., Breinl, Eckart
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.05.1998; Elsevier
• Subjects: Adult; Biological and medical sciences; complications; Fallopian Tubes - surgery; Female; Genitalia, Female - surgery; Humans; Hysterectomy - adverse effects; Injuries of the urinary system. Foreign bodies. Diseases due to physical agents; Laparoscopic surgery; laparoscopically assisted vaginal hysterectomy; Laparoscopy - adverse effects; Medical sciences; Ovariectomy - adverse effects; Traumas. Diseases due to physical agents; Ureter - injuries; Ureteral Diseases - etiology; ureteral injuries; Urinary Fistula - etiology; Vaginal Fistula - etiology; laparoscopically assisted vaginal hysterectomy; Laparoscopic surgery; complications; ureteral injuries; Human; Endoscopic surgery; Urinary system disease; Gynecology; Ureteral disease; Intraoperative; Laparoscopy; Urinary tract disease; Trauma; Female genital diseases; Vaginal route; Surgery; Complication; Female; Ureter; Bibliographic review
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/S0002-9378(98)70532-0

OBJECTIVE: The study assessed the incidence, diagnosis, management, and causes of ureteral injuries during major laparoscopic operations at our department in a 6-year period. STUDY DESIGN: The study was a chart review of 790 consecutive major laparoscopic procedures in 711 patients (mean age 37.4 ± 11.6 years, mean weight 64.3 ± 29.1 kg). RESULTS: There were four ureteral complications in three patients during or after laparoscopic operations: three of 711 patients (0.42%) and four of 790 procedures (0.38%). All three ureteral complications (one transection and a total of three ureterovaginal fistulas in two patients) occurred during laparoscopically assisted vaginal hysterectomies, for an incidence of 4.3%. There were no ureteral injuries in 291 salpingo-oophorectomies, 414 ovarian cystectomies, and 15 colposuspensions. Both delayed ureteral complications occurred in the lower segment of the ureter after laparoscopic bipolar coagulation and division of the cardinal ligament. CONCLUSION: We conclude that in laparoscopic surgery the ureter is most at risk when the cardinal ligament is dissected and divided below the uterine vessels. (Am J Obstet Gynecol 1998;178:967-70.)