What is the role of laparoscopy and robotic techniques in the treatment of iatrogenic ureteral injury?

Updated: Nov 12, 2020
  • Author: Sandip P Vasavada, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

The rapid adoption of laparoscopic and robotic techniques over the past 2 decades by urologists and other surgical specialists, along with the increased use of ureteroscopy, has increased the risk of ureteral injury. However, in a study of 459 consecutive robotic gynecologic surgery cases, Jones et al reported that conversion to open surgery because of ureteral injury was required in only one case. [20]

New surgical techniques have also increased the need for new preventive techniques. [21, 22]  For example, lighted stents have been used to assist in identifying the location of the ureters during laparoscopic surgery to help prevent iatrogenic injury. If the lighted stents are not visible during laparoscopic surgery, four options are available, as follows:

  • Reduce the intensity of the laparoscopic lighting. By dimming the lights, the light from the stent may become visible
  • Change the camera to a different port
  • Identify the ureter where it is visible and follow it down to the surgical field
  • Convert to an open procedure so that the ureter can be palpated and identified

Robotic techniques also have the potential for use in repair of ureteral injury. In a review of 43 cases of robot-assisted repair of injuries to the ureter or bladder that occurred during obstetrical and gynecological surgical procedures, Gellhaus et al concluded that robotic repair is associated with good outcomes, appears safe and feasible, and can be used immediately after injury recognition or as a salvage procedure after prior attempted repair. [23]


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