URETERAL INJURIES

Posted by e-Medical PPT Friday, March 2, 2012

CONDITIONS ASSOCIATED WITH URETERAL INJURIES
  Inadequate incision
• Inadequate retraction
• Poor lighting
• Visibility limited by bleeding
• Digression from standard techniques
(i.e. operative laparoscopy)

CONDITIONS ASSOCIATED DURING ABDOMINAL SURGERY
Obesity
• Large adherent pelvic mass
• Ureteral anomalies
• Intraligamentary leiomyomas
• Prior pelvic surgery
• Paracervical tissue induration
     A) Infection B) Cancer*

CONDITIONS ASSOCIATED DURING VAGINAL SURGERY
Uterine prolapse – remember the
“knee”
• Anterior repair – ureters are about
1 cm from sutures
• Aggressive, “lateral plication” of
U-S ligaments

AVOIDING URETERAL INJURIES -TRANSABDOMINAL
• Operate in spaces
• “The sidewall is your friend”
• Avoid large clamps and massive
ligatures when attempting hemostasis
in cardinal ligament area
• Avoid excessive use of cautery
• Widely mobilize bladder

AVOIDING URETERAL INJURIES - TVH
• Separately isolate bladder pillars
• Develop vesicouterine space –
countertraction beneath bladder
• Use small pedicles for cardinal and U-S
ligament ligation.
• ↔Palpate
• Culdoplasty sutures through U-S
ligaments – never lateral

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