7897 Bladder Injury Caused by Uterine Manipulator

Abstract

<h3>Study Objective</h3> This video demonstrates identification and management of a bladder injury caused by a uterine manipulator <h3>Design</h3> Surgical video <h3>Setting</h3> Academic medical center <h3>Patients or Participants</h3> A 34-year-old G0 with endometriosis, bilateral endometriomas, and subserosal fibroids desiring fertility underwent a robotic-assisted abdominal exploration with excision of endometriosis and myomectomy. Uterine manipulator was placed at the start of the case. Exposure to the surgical field was limited by inadequate uterine manipulation, which was thought to be attributed to the significant adhesive disease. At the start of the anterior compartment dissection, it was suspected that the uterine manipulator tip may have perforated into the bladder. A 3mm perforation was confirmed on cystoscopy. <h3>Interventions</h3> A bladder flap was further developed but the defect was too caudal to be accessed in this plane. The space of Retzius was entered and intentional cystotomy was made. The bladder injury was repaired transvesically with 2 sutures of 2-0 PDS. An additional suture was placed in the vagina to close the vaginal aspect of defect. The cystotomy was closed in a traditional 2-layer fashion. <h3>Measurements and Main Results</h3> Repeat cystoscopy confirmed a watertight closure of the bladder injury and the intentional cystotomy repair. The retropubic space was reperitonealized. The patient did well post-operatively with bladder decompression with foley catheter for 10 days. Subsequent CT cystogram showed no leakage of urine. The catheter was removed after the post-op imaging and a voiding trial. <h3>Conclusion</h3> This case highlights a rare complication of uterine manipulator use. There are benefits of using uterine manipulators especially in cases of advanced endometriosis and laparoscopic hysterectomy are well known and hence used readily in minimally invasive gynecologic surgery. It is therefore important to be aware of potential complications and have knowledge of how to address them.