Ureteral complications with operative gynecologic laparoscopy.

Abstract

The study assessed the incidence, diagnosis, management, and causes of ureteral injuries during major laparoscopic operations at our department in a 6-year period. The study was a chart review of 790 consecutive major laparoscopic procedures in 711 patients (mean age 37.4 +/- 11.6 years, mean weight 64.3 +/- 29.1 kg). There were four ureteral complications in three patients during or after laparoscopic operations: three of 711 patients (0.42%) and four of 790 procedures (0.38%). All three ureteral complications (one transection and a total of three ureterovaginal fistulas in two patients) occurred during laparoscopically assisted vaginal hysterectomies, for an incidence of 4.3%. There were no ureteral injuries in 291 salpingo-oophorectomies, 414 ovarian cystectomies, and 15 colposuspensions. Both delayed ureteral complications occurred in the lower segment of the ureter after laparoscopic bipolar coagulation and division of the cardinal ligament. We conclude that in laparoscopic surgery the ureter is most at risk when the cardinal ligament is dissected and divided below the uterine vessels.