title: Outcome of laparoscopic repair of ureteral injury: follow-up of twelve cases.
abstract: OBJECTIVE
  To review the feasibility of laparoscopic repair in cases of ureteral injuries occurring during gynecologic laparoscopy.
  
  
  METHODS
  Retrospective study (Canadian Task Force classification II-3).
  
  
  METHODS
  Institution-specific retrospective review of data from a tertiary referral medical center.
  
  
  METHODS
  Patients suffering from iatrogenic ureteral injuries diagnosed during or after surgery, and cases with deliberate ureteral resection and repair because of underlying disease.
  
  
  RESULTS
  We conducted a retrospective review of all (10 345) laparoscopic gynecologic surgeries performed in our institute between February 2004 and November 2008. Twelve cases (median: 45.5 years, range: 27-63) of ureter transections were diagnosed and repaired laparoscopically by endoscopists. Of these, 10 had previous surgeries, pelvic adhesions, or a large pelvic-abdominal mass. One patient had undergone a segmental resection and laparoscopic ureteroureterostomy for deep infiltrative endometriosis. Of the remaining 11 iatrogenic ureteral transections, 10 were repaired via laparoscopic ureteroureterostomy, whereas 1 had undergone a laparoscopic ureteroneocystostomy. One injury was recognized on the second postoperative day, but intraoperative recognition was attained in 11 cases. The median duration of double J stenting was 73 days. Three patients had development of strictures (between 42 and 79 days after surgery) treated with restenting, but 1 had to undergo an ureteroneocystostomy for ureter disruption when trying to restent. One patient had development of leakage of the anastomotic site but recovered with a change of the double J stent. Only 1 case required another laparotomy for ureteroneocystostomy. Laparoscopic primary repair of ureteral injury was successful for 11 of 12 patients. All the patients were well and symptom free at the conclusion of the study period.
  
  
  CONCLUSIONS
  Early recognition and treatment of ureteral injuries are important to prevent morbidity. Laparoscopic ureteroureterostomy could be considered in transections of the ureter where technical expertise is available. To the best of our knowledge, this is the largest series, to date, of ureteral repairs via laparoscopy.
authors.affiliation: Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Chien-Min
authors.initials: CM
authors.lastname: Han
authors.forename: Heng-Hao
authors.initials: HH
authors.lastname: Tan
authors.forename: Nari
authors.initials: N
authors.lastname: Kay
authors.forename: Chin-Jung
authors.initials: CJ
authors.lastname: Wang
authors.forename: Hsuan
authors.initials: H
authors.lastname: Su
authors.forename: Chih-Feng
authors.initials: CF
authors.lastname: Yen
authors.forename: Chyi-Long
authors.initials: CL
authors.lastname: Lee
mesh_terms: D000291:Adnexal Diseases / Q000601:surgery; D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D007431:Intraoperative Complications / Q000601:surgery*; D010535:Laparoscopy; D008875:Middle Aged; D010052:Ovariectomy / Q000009:adverse effects; D012189:Retrospective Studies; D058994:Salpingectomy / Q000009:adverse effects; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000293:injuries* / Q000601:surgery*; D014591:Uterine Diseases / Q000601:surgery