Laparoscopic End-to-End Reanastomosis on the Distal Ureter

نویسنده

  • C. Y. Liu
چکیده

Abstract Laparoscopy succeed in overcoming technical difficulties and poor outcome of traditional open ureteroureteral distal anastomosis. A technique for laparoscopic repair of injury involving the distal ureter has been successfully developed. Introduction Injury to the ureter occurs in 0.1% to 1.5% of pelvic surgeries (Thomson, 1997; Saidi MH and al, 1996). Frequency is increasing as a result of greater number of complex endoscopic procedures with anatomical distortions being performed. Although it has to be underlined that studies reveal that most ureteral injuries occur during simple routine pelvic surgeries, such as an uncomplicated hysterectomy (Harkki-Siren P, 1998). It has been recognized that only one third of ureteral injury are detected during surgery. Instead, intraoperative recognition of ureteral injury is of paramount importance so that the damage can be repaired promptly before impairment of the renal function. Thus is necessary for all pelvic surgeons to be skilled in identifying and, if necessary, in dissecting out the entire pelvic ureter. The best way to prevent ureteral injury during laparoscopic surgery is to be certain of its location at all times during the procedure. In difficult pelvic surgery, ureteral dissection almost always requires a retroperitoneal approach. When there is doubt about the possibility of ureteral injury or when pelvic surgery is difficult, it is recommended to routinely perform cystoscopic examination. Ureteral obstruction or injury is suspected if no Indigo-carmine Dye, Methylen Blue Dye or urine effuses from the ureteral orifice. A 4-5 French sized whistle-tip ureteral catheter can be used to pass up the ureter in a retrograde fashion. It is crucial that urine is observed exiting the catheter and that the entire course of the ureter is observed laparoscopically. If resistance is met or if localization of the catheter is uncertain, a retrograde pyelogram should be performed by injecting contrast dye through the catheter. An x-ray is taken to determine the exact location of the obstruction. It has do be underlined that thermal injury to the ureter may be difficult to recognize intraoperatively. Regardless of whether the injury is recognized intraoperatively or detected postoperatively, surgery for ureteral reconstruction should adhere to the following recommendations:

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تاریخ انتشار 2017