Preset ureter catheter in laparoscopic radical hysterectomy of cervical cancer

Abstract

ABSTRACT. The aim of this study was to evaluate the clinical efficacy of a temporary ureteral catheter in preventing iatrogenic ureteral damage in cervical cancer patients undergoing laparoscopic radical hysterectomy. All cases had confirmed diagnoses of cervical cancer preoperatively between December 2008 and December 2012 in our hospital and were in clinical stages IA2 to IIA. In total, 176 laparoscopic radical hysterectomy and lymphadenectomy procedures were performed. The 176 cases were divided into two groups: ureteral catheters were installed using cystoscopy before the operation in 86 patients (group A), and ureteral catheters were not placed in 90 patients (group B). These cases were retrospectively analyzed based on postoperative hospitalization time and intraoperative and postoperative complications. A total of 6 cases (3.41%) had ureteral injuries, and 4 of the cases (4.65%) of ureteral injuries occurred in group A. In two of these cases, urinary leaking appeared at the post-operative 8th and 9th days and at the 10th and 25th days, respectively. There were 2 cases (2.22%) of ureteral injuries in group B: 1 case of intraoperative direct Laparoscopic radical hysterectomy of cervical cancer injury and the other of urinary leaking, which appeared at post-operative day 21. Statistically significant differences between the two groups were observed in operating time and the incidence of hemorrhage, hematuria (including microscopic hematuria), post-operative urinary tract infection, and pain (P < 0.05). A ureteral catheter that is placed preoperatively can help to identify the ureter in laparoscopic radical hysterectomy, but does not decrease the incidence of ureteral injury.

Does prophylactic ureteral catheter placement offer any advantage for laparoscopic gynecological surgery? A urologist’ perspective from a systematic review and meta-analysis

“…Additionally, the incidence of ureteral injury is related to the types of operations performed at different periods and the surgeons' experience (16). The probability of ureteral injury in laparoscopic operations increases by 0.2-6.0% (2,17). Most doctors who can perform a radical hysterectomy have experience with laparotomy and basic laparoscopic surgery.…”

“…Most doctors who can perform a radical hysterectomy have experience with laparotomy and basic laparoscopic surgery. However, due to insufficient understanding of the anatomy around the cervix under the microscope, unskilled manipulation, and the use of electric energy devices, urinary tract injuries are prone to occur in the early stages of such surgery (17). Among these complications, IUI is one of the most serious complications (2).…”

“…Among these complications, IUI is one of the most serious complications (2). Furthermore, laparoscopic radical hysterectomy requires opening the ureteral tunnel, which also increases the chances of ureteral injury and other severe complications (17). Notably, although laparoscopic surgery has a higher risk of ureteral injury than laparotomy, patients prefer laparoscopic surgery over open surgery due to less scarring, shorter LOS and less postoperative pain (2,17).…”

Laparoscopic radical hysterectomy for cancer of the cervix uteri

“…Абсолютное большинство исследователей склоняются к мнению, что наиболее значимым превентивным фактором является опыт и уровень подготовки хирурга. Это в свою очередь диктует необходимость систематического тренинга и повышения квалификации специалистов [9,10].…”

Robotic Hysterectomy for Cancer and Benign Pathology

“…Urologic injuries can be prevented by thoroughly identifying the ureter and careful surgical technique avoiding excessive devascularization of the ureter and excessive use of the cautery. The use of prophylactic stents in conventional laparoscopy and laparotomy has not shown to be cost effective for the prevention of urologic injury and has not been studied in robotic-assisted gynecologic surgery [77,78]. Bowel and vascular injuries have a low incidence and similar causes than conventional laparoscopic surgery.…”