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Query: UMLS:C0403608 (ureter)
 9,655 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This retrospective study examined ureteral injuries during gynecologic operations from January 1980 to August 1985. The study was conducted at two private hospitals that are involved in resident teaching programs. Each patient was reviewed for predisposing factors, location and type of injury and time and method of recognition. Sixteen injuries were documented in 1,093 extensive procedures. Twelve injuries occurred at the pelvic brim and four others occurred elsewhere in the pelvis. Risk factors included previous surgical procedures in the pelvis, endometriosis, ovarian neoplasm, pelvic adhesions, distorted anatomic features of the pelvis and repair of the bladder. The anatomic structure of the ureter is reviewed, and recommendations are made to help prevent ureteral injury during surgical procedures in the pelvis.
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PMID:Injury to the ureter during gynecologic surgical procedures. 338 Nov 80

Eleven patients with stage IA2-IIA carcinoma of the cervix have been treated by combined laparoscopic-vaginal radical hysterectomy and bilateral pelvic lymphadenectomy (3-Stage IA2, 5-stage IB, 3-Stage IIA). The patients were unselected. Three patients had bulky (&gte; 5 cms) tumors, one of whom weighed 239 lbs; one had prior anterior-posterior repair, was apareunic and had significant vaginal narrowing; two patients had extensive pelvic adhesions, one of whom also had a 480 gram uterus. Pelvic lymph node metastases were present in one patient and paracervical lymph node metastases in one. The technique used has undergone significant modification. The laparoscopic phase of the procedure contributes much more to the operation than the lymphadenectomy for it allows a symbiotic partitioning of the operation into the laparoscopic and vaginal components. Only those steps of the operation are carried out vaginally that are easier to perform from below (division of the uterosacral and cardinal ligaments, unroofing of the ureter), and they are made much easier by the preceding laparoscopic phase of the operation. Laparoscopic development of the para-vesical and para-rectal spaces makes vaginal entry into these spaces very straightforward, and laparoscopic division of the uterine artery facilitates vaginal unroofing of the ureter. By allowing the proximal ureter to be freed from the medial leaf of the broad ligament, and the proximal attachments and blood supply of the uterus to be divided, the laparoscopic phase of the operation also permits the cervical ligaments to be divided before the ureters are freed from the vesico-cervical ligament, which helps to avoid a Schuchardt incision in most patients.
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PMID:Laparoscopic-Vaginal Radical Hysterectomy 907 93

OBJECTIVE To determine whether a novel port (QuadPort, Advanced Surgical Concepts, Wicklow, Ireland) can facilitate transvaginal nephrectomy (TN), a natural orifice transluminal surgery (NOTES) procedure, using standard and articulating laparoscopic instruments. MATERIALS AND METHODS Four fresh female cadavers were used in this feasibility study with a plan to perform two right-sided and two left-sided TN. Exclusion criteria were a history of nephrectomy and a height of >1.82 m. The cadaver was placed in the lithotomy position with the target side up 30-45 degrees . A three-channel R-port (Advanced Surgical Concepts) was placed in the umbilicus to monitor the transvaginal procedure. The four-channel QuadPort was placed through the posterior fornix into the peritoneal cavity. Regular laparoscopic instruments were used transvaginally to mobilize the colon, dissect the ureter, identify and divide the renal artery between clips, and divide the renal vein with a laparoscopic stapler. Remaining attachments of the kidney were divided and the specimen entrapped in a plastic bag before transvaginal extraction. RESULTS Three (two right- and one left-sided) TNs were performed successfully; one left-sided TN was aborted in the last cadaver due to dense pelvic adhesions from previous pelvic surgery. In the first two cadavers we required assistance from the umbilical port only to divide the attachments between the upper pole of the kidney and the diaphragm supero-posteriorly. In the third case we were able to perform this dissection completely transvaginally using a flexible gastroscope. CONCLUSIONS A completely NOTES-based TN in humans is challenging. Robust laparoscopic instruments have the requisite tensile strength when deployed through a large calibre, secure, multichannel transvaginal port. Extra-long laparoscopic instruments are helpful. The cephalad aspect of the hilum and the upper pole attachments are difficult areas. Novel and robust flexible instruments still need to be developed.
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PMID:Transvaginal nephrectomy with a multichannel laparoscopic port: a cadaver study. 1948 91

From July 1, 2006 to June 30, 2007, 151 patients with complex pelvic pathology underwent placement of lighted ureteral stents by a general surgeon or gynecologist. None of the patients who underwent preprocedure ureteral stent placement had a ureteral injury. The procedures included laparoscopic colorectal surgery (45 pts), hysterectomy/GYN (49 pts), or pelvic adhesions (57 pts). The average time from placement of the stents to start of the operation was 5 minutes (range, 2 to 15). In 6 patients, the stents could not be placed, and all had ureteral pathology that was NOT noted preoperatively. Two patients had ureter injuries at our hospital and did not have ureteral stents placed during the same time period. The cost of the stents is $205. OR time past the first half hour ranges from $560 to $716 for each additional half hour. The time saved from the lighted identification of the ureters versus visual nonstent identification is from zero minutes to 45 minutes. This is an extremely useful procedure that can theoretically reduce ureter injury to zero. In an era in which insurance will not pay for complications related to the original operation and high litigation costs, this procedure should be the standard of care for safely performing complex pelvic surgery.
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PMID:Protect the ureters. 1966 Feb 5

A 41-year-old woman referred to us with dysmenorrhea and severe pelvic pain although she was previously submitted to right laparotomic adnexectomy for ovarian endometrioma and to a subsequent operative laparoscopy for pelvic adhesions. After ultrasound examination, the patient underwent diagnostic hysteroscopy and operative laparoscopy which confirmed the clinic suspect of an unicornuate uterus. However, it was very unusual to see an extremely distanced right horn, without communication with uterus, without adnexa, and with a small myoma belonging to it. Moreover, omentum and bowel were attached to fundus of right horn and thick adhesions fixed it to rectum and right pelvic wall. Therefore, identification of anatomical structures was difficult, as it was extremely arduous to isolate the ureter, which was involved inside the adhesions surrounding the right uterine horn. Nevertheless, laparoscopic right hemihysterectomy was successfully performed and right horn was sent to our pathologist who recognized hypotrophic endometrium and adenomyosis.
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PMID:An unusual extremely distant noncommunicating uterine horn with myoma and adenomyosis treated with laparoscopic hemihysterectomy. 2410 32