title: Utility of an Internal Retractor (EndoGrab) for the Management of the Vesicouterine Ligament during Laparoscopic Radical Hysterectomy.
abstract: OBJECTIVE
  The study aims to prevent serious urologic injury during a radical hysterectomy; we propose that one of the most important procedural steps is the careful management of the vesicouterine ligament (VUL).
  
  
  METHODS
  Between January 2013 and October 2014, we used a novel internal retractor in 17 patients undergoing a laparoscopic radical hysterectomy (LRH) for early-stage cervical cancer to obtain and secure a better surgical view. For management of the VUL during the laparoscopic procedure, we routinely used an internal retractor (EndoGrab; Virtual Ports, Misgav, Israel) and vessel tape to reposition the ureter in a safe lateral-caudal direction.
  
  
  RESULTS
  Using an EndoGrab, we were easily able to reproduce a suitable surgical view that simulated the one obtained by an abdominal route for radical hysterectomy. Using this improved laparoscopic procedure, we completed radical hysterectomies in all 17 cases without a ureteral injury complication.
  
  
  CONCLUSIONS
  Our modified method using an EndoGrab is effective for the prevention of ureteral injury during a LRH, and its ease of use makes it suitable even for those surgeons early in their laparoscopic learning curve.
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kobayashi
authors.forename: Mamoru
authors.initials: M
authors.lastname: Kakuda
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Akiko
authors.initials: A
authors.lastname: Morimoto
authors.forename: Tomomi
authors.initials: T
authors.lastname: Egawa-Takata
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuzaki
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ueda
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yoshino
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007431:Intraoperative Complications / Q000517:prevention & control; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D008022:Ligaments; D008207:Lymphatic Metastasis; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D014513:Ureter / Q000293:injuries; D001743:Urinary Bladder; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D014599:Uterus