Sites prone to ureteral injury during complex gynaecological surgeries and preventive strategies: a case series

INTRODUCTION: Ureteral injuries (UIs) remain a major challenge to clinicians in complex gynecological surgery. In this study, we employed three cases to demonstrate the locations of the ureter prone to injury and the process of blunt ureterolysis, thereby avoiding UIs. CASE REPORT: Case 1 had undergone laparotomy ovarian cystectomy before. During the operation, extensive, sheet-like adhesions between the intestine, right ureter, and ovarian suspensory ligament were observed, and the ureter's appearance was strikingly similar to that of the right ovarian suspensory ligament. Case 2 presented with concurrent ovarian endometrioma and pelvic endometriosis, involving the right posterior broad ligament and the uterosacral ligament, both of which were extremely close to the right ureter. Case 3 demonstrated the process of uncovering the ureteral tunnel during radical surgery for cervical cancer, with particular emphasis on the handling of the ureteral knee-like structure. CONCLUSIONS: To effectively prevent UIs during complex gynecological surgeries, surgeons should integrate knowledge of ureteral anatomy, recognize injury-prone locations, and proficiently perform ureteral dissection with appropriate surgical instruments. This study provides a detailed description of the procedures to avoid UIs, offering a reference for clinicians to accumulate practical experience.