Abstract
Ureter injuries are uncommon but dreaded complications in gynecologic surgery and a frequent cause of conversion to laparotomy. Recently, a few papers reported the repair of gynecologic ureteral injuries using laparoscopy with encouraging results. In these case reports, we aimed to present two laparoscopically repaired ureter injuries during total laparoscopic hysterectomies (TLH). In the first case, the ureter was transected during the dissection of the cardinal ligament, approximately 7 to 8 cm distal to the ureterovesical junction (UVJ), and in the second case, it was damaged approximately 10 cm distal to the UVJ. Both transections were identified during surgery. The injured ureter was repaired without converting to laparotomy or additional trocar insertion. Ureteroureterostomy was performed in both cases uneventfully. Although ureteric injury is a rare complication during TLH, it can be managed by the same surgeon laparoscopically during the same procedure.
Highlights
Urologic complications during gynecologic surgery are uncommon but dreadful
We aimed to present two laparoscopically repaired ureter injuries during total laparoscopic hysterectomies (TLH)
Ureteric injury is a rare complication during TLH, it can be managed by the same surgeon laparoscopically during the same procedure
Summary
Urologic complications during gynecologic surgery are uncommon but dreadful. The reported incidence of ureteral injury related to gynecologic surgery varies between 2.5% and 12.1%(1). The approach of hysterectomy plays a role in the variation of incidence in total laparoscopic hysterectomies (LHs) (TLHs) compared with the abdominal and vaginal approach; the reported odds ratio for urinary tract injuries was 2.41 and 3.69, respectively[2]. The question is whether complications of laparoscopic procedures such as ureteral injury could be managed successfully and effectively without converting to laparotomy. We report successful immediate primary laparoscopic repair of two cases of ureter transection during TLH and discuss possible causes that lead to ureter injury and make recommendations for prevention
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