Areas of risk for ureteral lesion during radical hysterectomy
Tanchev, L.; Gortchev, G.; Tomov, S.; Khinkova, N.; Tzvetanova, K.
Akusherstvo i Ginekologiia 52(1): 13-17
2013
ISSN/ISBN: 0324-0959 PMID: 23805455 Document Number: 670752
The close interrelations of the pelvic ureter with surrounding structures and organs are a prerequisite for complications during surgical interventions in the lesser pelvis. Exploration and visualization of the areas of risk for lesion of pelvic ureter during minimally invasive radical hysterectomy. Based on our observations and the available literature, we identified the following areas and steps of the radical hysterectomy as risky: at the entrance in the lesser pelvis, upon ligation of the infundibulopelvic ligament; incision of the back leaf of broad ligament of the uterus; dissection of the pararectal space; ligation of the uterine artery; dissection of the fourth space and transection of the vesicouterine ligaments; transection of the sacrouterine ligaments; incision of the anterior vaginal wall. We registered one uretero-vaginal fistula in a total of 133 patients on the eighth postoperative day. The lesion was identified in area of the distal portion of ureter. Knowledge about the ureter location, its interrelations with surrounding structures, and its blood supply, combined with capable surgical techniques, would contribute to reduction of the incidence of complications.