Laparoscopic dissection of the ureter for radical laparoscopic hysterectomy

The most important step in radical hysterectomy is freeing the ureter from the anterior parametrium. In this paper we describe our modified technique for freeing the ureter from the anterior parametrium for a Piver II–III radical hysterectomy by means of pure laparoscopic surgery. Our series consists of seventeen patients undergoing laparoscopic hysterectomy. In evaluating the technique, we considered its feasibility, the operating time, the time for complete preparation of the ureter as measured on the videotapes of the procedures, the short-term complication rate, and the length of hospital stay. Thirty-one ureters were unroofed; in three patients, monolateral dissection was performed. The median time of the surgical procedures was 182 min (range 110–255). The median time to unroof the ureter on one side was 14 min 35 s (range 10 min 15 sec–63 min). No patient had ureteronephrosis at ultrasound at control. Even if the experience with this technique is limited, the almost constant time to free the ureter shows that, laparoscopically, it can be performed with relative ease, particularly in patients without prolapse.