Laparoscopic hysterectomy: is dissecting the ureter necessary?

Laparoscopic hysterectomy has been first reported by Reich et al. in 1989, which confirmed the possibility of laparoscopic hysterectomy being employed as a replacement of the vast majority of traditional abdominal hysterectomies. There are three critical points in laparoscopic hysterectomy. The most important critical point is to identify uterine arteries from the ureter in the paracervical area. Several ureteral injuries at operative laparoscopy have been reported. We performed two hundred and thirty laparoscopic hysterectomies during the period from March 1991 to October 1993. Sixty patients were later included in this study. Thirty of these applied the technique of dissecting the ureter at the initiation of laparoscopic hysterectomy. Most of the patients were discharged on the second postoperative day. Although dissecting the ureter at the beginning of the operation did not produce a significant discrepancy in operation time, blood loss, hospitalization day and ureter injury when compared with the control group, the uterine arteries, however, may be confidently desiccated once the path of the ureter near the uterosacral ligament is identified.