The Impact of Minimally Invasive Surgery on Major Iatrogenic Ureteral Injury and Subsequent Ureteral Repair During Hysterectomy: A National Analysis of Risk Factors and Outcomes

Packiam, Vignesh T.; Cohen, Andrew J.; Pariser, Joseph J.; Nottingham, Charles U.; Faris, Sarah; Bales, Gregory T.

doi:10.1016/j.urology.2016.06.041

Cited by 34 publications

(19 citation statements)

References 22 publications

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“…Ureteral injuries are potential complications of gynecologic procedures. 9 Its incidence varies greatly depending on the procedure performed: from 0.04-2% in vaginal hysterectomies, 1,4 0.3-1.3% in robotic/laparoscopic hysterectomy 4,10 and 0.18%-1% in abdominal hysterectomies 4,5 , to 1-11% in uterosacral ligament colposuspension. 6,7,11 A study in a tertiary-level care center showed that ureteral repair was needed in 0.26% of the 6422 patients studied, all of which had undergone gynecologic surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…2 Gynecological interventions account for 52 to 82% of reported ureteral injuries, 1,3 and the incidence of ureteral lesions ranges from approximately 0.04% to 11% in gynecological surgeries. 1,[4][5][6][7] Ideally, ureteral injuries should be identified and treated intraoperatively. Nonetheless, most injuries go unnoticed until the postoperative period, 3 when patients present clinical symptoms such as lower back pain, nausea or vomiting; or findings suggestive of peritonitis, fever or leukocytosis.…”

Section: Introductionmentioning

confidence: 99%

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Transvaginal repair of ureteral transection post gynecological surgery: a case report

et al. 2019

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Introduction: Ureteral injuries are relatively common in gynecological procedures. The repair of such injuries has traditionally been done through open surgery; however, minimally invasive techniques have become an option in some cases. We report the case of a ureteroureteral anastomosis successfully transvaginally approached. Case report: a 70-year-old woman developed hydronephrosis and acute renal failure after vaginal hysterectomy, parametrectomy, McCall culdoplasty, sacrocolpopexy, posterior colpoplasty and perineoplasty. She was reoperated, and had bilateral ureteral injuries correctly identified and repaired through the vaginal route. Discussion: Difficulties encountered during transvaginal surgery include ureter identification and the narrow surgical field. In order for a vaginal repair to be performed, surgeons must have expertise with vaginal surgery and know the anatomy of the ureter as seen through the vagina. Additionally, JJ stents can be used to facilitate repair. Conclusion: Vaginal repair of ureteral injuries is feasible and has potentially less morbidity than the standard abdominal approaches, but further studies are needed in order to determine its efficacy and complication rates.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transvaginal repair of ureteral transection post gynecological surgery: a case report

et al. 2019

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“…There is still a lack of data about ureteral lesions during laparoscopic or robotic surgeries. A recent national analysis of Packiam et al showed that the minimally invasive approach for hysterectomy is an independent risk factor for iatrogenic ureteral injuries 2 . Ureteral lesions are often considered a complication of gynecological and urological surgery due to the anatomic proximity of bladder, prostate, and reproductive organs to the pelvic ureter and they are much less likely to be recognized intraoperatively when compared with bladder injuries.…”

Section: Discussionmentioning

confidence: 99%

Robotic “Side Hole” Technique Placement of Ureteral Stent for Ureteral Lesion

Falavolti

Pagliarulo

Sergi

et al. 2017

Urology Case Reports

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A 67-year-old patient underwent robotic-assisted laparoscopic radical prostatectomy and experienced right ureteral lesion. The laceration was recognized intraoperatively and immediately repaired over the ureteral double J stent. The wire and the stent were first advanced distally to the bladder. Then the wire was pulled with its soft end, cranially through one of the side holes of the proximal end of the stent toward the kidney allowing exact positioning of the stent. Postoperative hospitalization was similar to a classic laparoscopic robotic-assisted prostatectomy. Robotic approach and the “side hole” technique represent an accurate and safe option in case of ureteral laceration management.

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“…Intraoperative ureter identification is most often achieved by visual inspection and palpation. Both can be more challenging during laparoscopic procedures, translating into a higher risk of IUI [ 6 , 7 ]. An alternative and effective method to identify IUI is cystoscopy, whereby the ureteral jets are visualized using a urine colouring dye [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Currently available and experimental dyes for intraoperative near-infrared fluorescence imaging of the ureters: a systematic review

et al. 2019

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Background Iatrogenic ureteral injury (IUI) following abdominal surgery has a relatively low incidence, but is associated with high risks of morbidity and mortality. Conventional assessment of IUI includes visual inspection and palpation. This is especially challenging during laparoscopic procedures and has translated into an increased risk of IUI. The use of near-infrared fluorescent (NIRF) imaging is currently being considered as a novel method to identify the ureters intraoperatively. The aim of this review is to describe the currently available and experimental dyes for ureter visualization and to evaluate their feasibility of using them and their effectiveness. Methods This article adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard for systematic reviews. A systematic literature search was performed in the PubMed database. All included articles were screened for eligibility by two authors. Three clinical trial databases were consulted to identify ongoing or completed unpublished trials. Risk of bias was assessed for all articles. Results The search yielded 20 articles on ureter visualization. Two clinically available dyes, indocyanine green (ICG) and methylene blue (MB), and eight experimental dyes were described and assessed for their feasibility to identify the ureter. Two ongoing clinical trials on CW800-BK and one trial on ZW800-1 for ureter visualization were identified. Conclusions Currently available dyes, ICG and MB, are safe, but suboptimal for ureter visualization based on the route of administration and optical properties, respectively. Currently, MB has potential to be routinely used for ureter visualization in most patients, but (cRGD-)ZW800-1 holds potential for this role in the future, owing to its exclusive renal clearance and the near absence of background. To assess the benefit of NIRF imaging for reducing the incidence of IUI, larger patient cohorts need to be examined. Electronic supplementary material The online version of this article (10.1007/s10151-019-01973-4) contains supplementary material, which is available to authorized users.

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The Impact of Minimally Invasive Surgery on Major Iatrogenic Ureteral Injury and Subsequent Ureteral Repair During Hysterectomy: A National Analysis of Risk Factors and Outcomes

Cited by 34 publications

References 22 publications

Transvaginal repair of ureteral transection post gynecological surgery: a case report

Transvaginal repair of ureteral transection post gynecological surgery: a case report

Robotic “Side Hole” Technique Placement of Ureteral Stent for Ureteral Lesion

Currently available and experimental dyes for intraoperative near-infrared fluorescence imaging of the ureters: a systematic review

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