An easier ureteral tunnel approach during laparoscopic-assisted radical vaginal hysterectomy

Abstract

Identification and mobilization of the ureters is the most difficult part of the Schauta operation and is the most risky and time-consuming step in laparoscopic radical hysterectomy. Since February 2003 we have used a modified technique of laparoscopic radical hysterectomy for managing seven cases of stage IB1 cervical cancer. This technique is based on that described by Querleu–Dargent, but it includes a modified step to treat the parametria and the ureteral tunnel. Both ureters are identified and isolated by placing vessel loops. The ends of the vessel loop are placed into the vagina through the anterior colpotomy previously performed. Once in the vaginal route, gentle traction of the vessel loops allows easy identification and dissection of the ureter. Caudal parametrial management is the most time-consuming of the laparoscopic approaches, and a high risk of ureteral damage is always present. Depending on vaginal conditions, managing the proximal parametrium and ureters is difficult, and Schuchardt’s incision may be necessary. Laparoscopic vessel loop isolation of the ureters allows easier and safer vaginal management of the ureteral tunnel during laparoscopic vaginal radical hysterectomy.