Modified instruments for mobilization of the ureters and parametrial transsection during radical hysterectomy.

Abstract

The untunneling of the ureters and the transsection of the parametria are two well-characterized steps of radical hysterectomy. Two sets of instruments were developed to facilitate the mobilization (untunneling) of the ureters and the dissection of the paravaginal and parametrial tissues during radical hysterectomy. Instrument set one consists of a modified Uchida spoon, two ureteral tunnel clamps, and a pair of tunnel scissors. Set two contains a long and a short sharply angled parametrial clamp with matching parametrial scissors. This technique permits one-step exposure of the ureter, protected from injury by the spoon. The instruments for parametrial transsection facilitate controlled transsection of the paravaginal and parametrial tissues while conserving surgical margins. They can also be conveniently used for transsection of the uterosacral ligaments. The authors believe that the instruments contribute to an enhanced safety and accuracy of radical hysterectomy with improved efficiency by shortened operating time.