title: Intraoperative Ureteral Kinking During Uterosacral Ligament Suspension: Effect of Training Level on Occurrence.
abstract: OBJECTIVE
  To determine the rate of ureteral kinking during uterosacral ligament suspension (USLS) procedures at a tertiary referral center and to describe the effect of surgical training level on this occurrence. The secondary aim is to determine the mean additional anesthesia time associated with management of this complication.
  
  
  METHODS
  This retrospective cohort study included all USLS procedures at our tertiary referral center from June 2011 to December 2013. Cases of USLS with ureteral kinking were compared to uncomplicated cases to determine the impact of surgeon training level on this occurrence.
  
  
  RESULTS
  A total of 161 USLS procedures were performed during the study period; 10 had ureteral kinking (6.2%). Level of surgeon training significantly impacted ureteral kinking, with higher rates of kinking occurring among surgeons in earlier training. The occurrence of ureteral kinking during USLS significantly increased the procedure. time by a mean of 86 minutes when the surgery included vaginal hysterectomy and anterior/ posterior colporrhaphy (266.5±34.6 min vs. 180.1 ±43.0 min, respectively; p=0.0078).
  
  
  CONCLUSIONS
  Ureteral kinking occurred in 6.2% of USLS procedures at a tertiary referral center and is associated with a learning curve with statistically significant higher kinking rates among less experienced surgeons. Novel teaching methods should be considered to reduce the learning curve for this procedure.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Richter
authors.forename: Jenine
authors.initials: J
authors.lastname: Boileau
authors.forename: Megan
authors.initials: M
authors.lastname: Janni
authors.forename: Eshetu
authors.initials: E
authors.lastname: Tefera
authors.forename: Cheryl B
authors.initials: CB
authors.lastname: Iglesia
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D008022:Ligaments / Q000601:surgery*; D012189:Retrospective Studies; D066231:Surgeons / Q000706:statistics & numerical data*; D014599:Uterus / Q000601:surgery*