Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, Sutton, United Kingdom.
Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, Sutton, United Kingdom.
J Minim Invasive Gynecol. 2019 Mar-Apr;26(3):401. doi: 10.1016/j.jmig.2018.05.023. Epub 2018 Jun 13.
To demonstrate techniques of ureterolysis during complex laparoscopic hysterectomy.
Technical video demonstrating different approaches to ureterolysis for complex benign pathology during laparoscopic hysterectomy (Canadian Task Force classification III).
Benign gynecology department at a university hospital.
Performance of ureterolysis during laparoscopic hysterectomy for benign pathology.
Ureteric injury has significant morbidity and is the most common reason for litigation following hysterectomy, with an estimated risk of 0.02% to 0.4%. [1,2]. Ureterolysis is infrequently practiced by benign gynecologists; however, it may be necessary during complex surgery. Benign pathology requiring hysterectomy, such as endometriosis, myomas, large uteri, and adnexal masses, are recognized risk factors for ureteric injury [3]. Most injuries occur during division of the uterine artery at the level of the internal cervical os. The average distance between the ureter and cervix is 2 cm, but it is only 0.5 cm in 3.2% of the population with a normal pelvis [4]. Preventive strategies, such as the use of a uterine manipulator, may increase this distance, although it still might not be sufficient to prevent injury in women with normal anatomic variants and complex pathology. Visualizing the ureter at the pelvic brim and side wall without retroperitoneal dissection may be inadequate because the segment of ureter between the intersection of the uterine artery and the bladder is not visible. The ureter can be safely dissected up to 15 cm without compromising its viability. In this educational video, we demonstrate various simple, quick, and reproducible techniques to perform ureterolysis for complex benign pathology. These techniques can be used by both expert and novice surgeons to perform and teach ureterolysis. Our method determines the course of the ureter throughout the pelvis and relation to the uterine artery to reduce intraoperative injury. We have performed more than 350 cases with no injuries.
展示复杂腹腔镜子宫切除术中输尿管松解的技术。
技术视频演示了腹腔镜子宫切除术中治疗复杂良性病变时不同的输尿管松解方法（加拿大任务组分类 III）。
大学医院良性妇科科。
腹腔镜子宫切除术中对良性病变进行输尿管松解。
输尿管损伤具有显著的发病率，是子宫切除术后诉讼最常见的原因，估计风险为 0.02%至 0.4%。[1,2]。良性妇科医生很少进行输尿管松解术；然而，在复杂手术中可能是必要的。需要子宫切除术的良性病变，如子宫内膜异位症、肌瘤、大子宫和附件肿块，是输尿管损伤的公认危险因素[3]。大多数损伤发生在子宫动脉在宫颈内口水平切开时。输尿管与宫颈的平均距离为 2 厘米，但在骨盆正常的 3.2%人群中，其距离仅为 0.5 厘米[4]。预防性策略，如使用子宫操纵器，可能会增加这一距离，但对于骨盆解剖结构正常且病变复杂的女性，可能仍然不足以防止损伤。在没有腹膜后解剖的情况下，在骨盆边缘和侧壁处可视化输尿管可能不够充分，因为在子宫动脉与膀胱交界处之间的输尿管段不可见。可以在不损害其活力的情况下安全地将输尿管松解至 15 厘米。在这个教育视频中，我们展示了各种简单、快速和可重复的技术，用于治疗复杂的良性病变。这些技术可以由专家和新手外科医生使用，以进行和教授输尿管松解术。我们的方法确定了输尿管在整个骨盆中的走行及其与子宫动脉的关系，以减少术中损伤。我们已经进行了超过 350 例手术，没有发生损伤。
