URETERAL INJURY DURING GYNECOLOGICAL LAPAROSCOPIC SURGERIES： REPORT OF TWELVE CASES

GYNECOLOGICAL surgery is themajorcauseiatrogenic ureteral injury.More ureteral injurhave been reported these years as the frequenof gynecological laparoscopic surgeries is increasing.1Inmeta-analysis study,70cases in30published articles fro1966to2003were …

URETERAL INJURY DURING GYNECOLOGICAL LAPAROSCOPIC SURGERIES: REPORT OF TWELVE CASES

Objective To investigate ureteral injury during gynecological laparoscopic surgeries.Methods From January 1990 to December 2005, 12 868 gynecological laparoscopic surgeries were conducted in Peking Union Medical College Hospital with 12 ureteral injuries reported. The present study investigated several aspects, including surgical indications, uterine size, pelvic adhesion, operative procedures, symptoms, diagnostic time and methods, injury site and type, subsequent treatment, and prognosis.Results The incidence of ureteral injury was 0.093% (12/12 868) in all cases ,0.42% (11/2 586) in laparoscopic hysterectomy laparoscopically assisted vaginal hysterectomy ( LAVH) or total laparoscopic hysterectomy (TLH) ] , and 0.01% (1/10 282) in non-LAVH surgeries. Enlarged uterus, pelvic adhesion, and endometrosis were risk factors associated with ureteral injury. Only one injury was found intraoperatively while others were found postoper-atively. The injury sites were at the pelvic brim (2 cases) or the lower part of ureter (10 cases). Patients were treated with ureteral stenting (effective in 2 cases) or laparotomy and open repair. Prognoses were favorable in most cases.Conclusions Most laparoscopic ureteral injuries occur during laparoscopic hysterectomy. Further evaluation is required when ureteral injury is suspected, and surgical repair is the major treatment for ureteral injury.