It is estimated that 1% of patients with endometriosis have involvement of the urinary tract, with the bladder being the most common location. Ureteral endometriosis is a rare entity, and the majority of cases are found at exploratory laparotomy for extensive involvement of the pelvic organs. Obstruction of the ureter may be caused by extrinsic or intrinsic disease, with the extrinsic form occurring four times as often. Progressive ureteral obstruction can be insidious in onset and ultimately lead to renal failure. Hormone therapy has had variable success, and open surgery has been the mainstay of treatment. Only one case of ureteral endometriosis, both intrinsic and extrinsic, diagnosed at ureteroscopy has been reported previously. We present a case of ureteral obstruction secondary to isolated intrinsic endometriosis diagnosed at ureteroscopy and treated endoscopically with holmium laser ablation and leuprolide therapy.
aided by the improved performance and evolving ergonomics of these devices. The Hydrojet dissector has proven to be of enormous benefit in open liver resection. It allows precise parenchymal dissection and clear exposure of even the smallest vessels and biliary radicles. Its adoption in open surgery has been somewhat limited, with the established technologies of CUSA, bipolar electrocautery and ultrasonic technology enjoying more widespread adoption. In laparoscopic liver surgery, few centres routinely employ the Hydrojet. Our institution routinely employs Hydrojet for live donor hepatectomy and as such we have extensive experience with the device. We have employed Hydrojet regularly for laparoscopic hepatectomy and describe herein our technique of parenchymal division during major hepatectomy, combining the benefits of the Hydrojet and the Harmonic Scalpel. We demonstrate the precise parenchymal dissection made possible by the laparoscopic Hydrojet. We propose that this technique of liver resection is safe, efficient and precise.
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