Laparoscopic ureterolysis and dissection of the paravesical space for deeply scarred adnexal masses

M. Sami Walid, Richard L. Heaton
In: Archives of Gynecology and Obstetrics · 2009 · vol. 282(2) , pp. 173–175 · doi:10.1007/s00404-009-1245-3 · PMID:19841928 · W2050871079
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This paper reports two cases of laparoscopic hysterectomy and salpingo-oophorectomy requiring ureterolysis and describes a modified technique for this procedure with no ureteral injuries in over 15 years of practice.

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This paper reports two case experiences of laparoscopic hysterectomy and salpingo-oophorectomy for deeply scarred adnexal masses with severe adhesions to the pelvic sidewall, describing a modified laparoscopic ureterolysis technique and paravesical space dissection. Across more than 15 years of performing laparoscopic ureterolysis for various gynecologic indications, the authors state they did not observe ureteral injury attributable to ureterolysis, though they note uterine artery lacerations can occur during uterine artery ligation steps and can be managed without converting to open surgery. A key limitation is that the evidence is based on case reports and the authors’ cumulative procedural experience rather than a comparative study design. Relevance to endometriosis: the paper cites prior work on laparoscopic ureterolysis outcomes for ureteral endometriosis, though its own focus is primarily on ureterolysis technique for deeply scarred adnexal masses rather than endometriosis specifically.

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Abstract

IntroductionLaparoscopic ureterolysis is a delicate procedure that requires advanced laparoscopic skills.Materials and methodsWe are reporting two cases of laparoscopic hysterectomy and salpingo-oophorectomy with severe adhesions to the pelvic sidewall that required ureterolysis and describing a modified technique suitable for the laparoscopic performance of this procedure.ResultsIn more than 15 years of doing laparoscopic ureterolysis to deal with various gynecological cases, we have never had a ureteral injury related to the ureterolysis procedure. There have been uterine artery lacerations, usually when trying to apply clips for uterine artery ligation in which case the artery can be compressed with a clamp until it is reclipped, bipolar-cauterized or suture-ligated using intracorporeal knot tying. However, we did not have a single patient that required open surgery because of these lacerations.ConclusionBecause of the advantage of magnified viewing and laparoscopic dissection techniques which control small vessel bleeding, the laparoscopic route for ureterolysis is far easier to use than its open counterpart once it is learned. Laparoscopy, in addition, offers the added advantages of shorter hospital stay, reduced patient pain, reduced transfusion requirements and far better cosmetic results.
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Abstract

Introduction Laparoscopic ureterolysis is a delicate procedure that requires advanced laparoscopic skills.

Materials and methods

We are reporting two cases of laparoscopic hysterectomy and salpingo-oophorectomy with severe adhesions to the pelvic sidewall that required ureterolysis and describing a modified technique suitable for the laparoscopic performance of this procedure.

Results

In more than 15 years of doing laparoscopic ureterolysis to deal with various gynecological cases, we have never had a ureteral injury related to the ureterolysis procedure. There have been uterine artery lacerations, usually when trying to apply clips for uterine artery ligation in which case the artery can be compressed with a clamp until it is reclipped, bipolar-cauterized or suture-ligated using intracorporeal knot tying. However, we did not have a single patient that required open surgery because of these lacerations.

Conclusion

Because of the advantage of magnified viewing and laparoscopic dissection techniques which control small vessel bleeding, the laparoscopic route for ureterolysis is far easier to use than its open counterpart once it is learned. Laparoscopy, in addition, offers the added advantages of shorter hospital stay, reduced patient pain, reduced transfusion requirements and far better cosmetic results. Similar content being viewed by others

References

Ghezzi F, Cromi A, Bergamini V, Serati M, Sacco A, Mueller MD (2006) Outcome of laparoscopic ureterolysis for ureteral endometriosis. Fertil Steril 86(2):418–422 Okumura A, Murakami K, Nozaki T, Fuse H (2005) Laparoscopic ureterolysis for idiopathic retroperitoneal fibrosis. Int J Urol 12(12):1079–1081 Wen CC, Wang DS (2005) Laparoscopic ureterolysis for benign and malignant conditions. J Endourol 19(6):710–714 Srinivasan AK, Richstone L, Permpongkosol S, Kavoussi LR (2008) Comparison of laparoscopic with open approach for ureterolysis in patients with retroperitoneal fibrosis. J Urol 179(5):1875–1878 Chen HY, Huang MC, Hung YC, Hsu YH (2006) Failure of laparoscopy to relieve ureteral obstruction secondary to endometriosis. Taiwan J Obstet Gynecol 45(2):142–145 Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Walid, M.S., Heaton, R.L. Laparoscopic ureterolysis and dissection of the paravesical space for deeply scarred adnexal masses. Arch Gynecol Obstet 282, 173–175 (2010). https://doi.org/10.1007/s00404-009-1245-3 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-009-1245-3

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