An initial experience with lighted ureteral catheters during laparoscopic colectomy.
Ureteral catheters are recommended when a difficult pelvic dissection is anticipated to minimize the risk of ureteral injuries. With the introduction of laparoscopic-assisted colectomy, it has become necessary to replace tactile with visual feedback. Lighted ureteral catheters (LUC) have been advocated for major laparoscopic pelvic surgery as a means of enhancing ureteral identification. However, the use of LUC has been anecdotal to this point. We present the first series of selectively used LUC during laparoscopic-assisted colectomy. Forty-nine consecutive laparoscopic-assisted colectomies were reviewed in which patients had LUC placed or not (NC) [LUC,24(49%); NC, 25(51%)]. Indications for catheter insertion included complicated diverticular disease, previous pelvic surgery, and obesity. The need for LUC was at the discretion of the surgeon. Data collected included catheter visualization, type of procedure, operative time, operating room cost, and catheter or ureteral complications. Catheters were visualized in 5 of 6 (83%) right colectomies and 15 of 18 (83%) left colectomies. Nonvisualization was because of migration to the bladder (2 cases) and dense inflammatory reaction (2 cases). No catheter complications or ureteral injuries occurred in either group. Operative time (LUC, 192 +/- 11.3 min, NC, 161.4 +/- 9.5 min) was significantly longer in the LUC group as a result of the time for catheter insertion and the greater complexity of the case. The operating room cost was similar in the two groups (LUC, $3488.63 +/- 259.01; NC, $3537.56 +/- 313.43). The results indicate that selected use of LUC does significantly increase operating time without significantly increasing operating room cost or operative morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)
Senagore
A J
AJ
Ferguson-Blodgett Digestive Disease Institute, Grand Rapids, Michigan.
Luchtefeld
M
M
D003082:Colectomy / Q000191:economics / Q000295:instrumentation*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D020706:Laparoscopes; D010535:Laparoscopy / Q000191:economics; D008029:Lighting; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000191:economics; D013997:Time Factors; D014513:Ureter / Q000293:injuries; D014546:Urinary Catheterization / Q000191:economics / Q000295:instrumentation*