Changing Trends in Incidence of Ureteric Injury in Difficult Total Laparoscopic Hysterectomies After Retroperitoneal Ureteric Dissection: Our 12 Years Experience

Abstract

Introduction: Laparoscopic surgeries can be challenging in difficult total laparoscopic hysterectomy (TLH) cases as the size, shape, mobility of uterus along with the bowel and recto-sigmoid adhesions are limiting factors. The close proximity of the ureter with the genital organs in the pelvis along with the use of electrosurgery makes it prone for injury.

Objective: To evaluate all cases of ureteric injury in difficult TLH cases in our institution in last 12 years and also evaluate the role of retroperitoneal ureteric dissection in prevention of its injuries.

Materials & methods: A retrospective analysis was conducted at Radhakrishna Multi-Speciality Hospital, Bengaluru from 2005- 2016. In the initial 6 years ureteric dissection was not done, while it was done in the later 6 years.

Results: From 2005-2010 the overall incidence of ureteric injury was 0.67% and in difficult TLH it was 5.4% while it reduced to nil from 2011-2016.

Conclusion: Retroperitoneal ureter dissection decreases the incidence of ureteric injury.

Keywords: Ureteric dissection; Total laparoscopic hysterectomy; Ureteric injury