A simple procedure for the prevention of ureteral injury in laparoscopic-assisted vaginal hysterectomy

Study Objective. To introduce a surgical technique to minimize the chance of ureteral injury during laparoscopic-assisted vaginal hysterectomy (LAVH). Design. Retrospective case review (Canadian Task Force classification II-3). Setting. Show Chwan Memorial Hospital, Changhua, Taiwan. Patients. Two thousand and six women who underwent LAVH between January 1992 and June 2001. Intervention. A simple step of creating a "window" over the anterior and posterior broad ligaments to push inferolaterally the areolar tissue (in which the ureter is embedded) on the posterior broad ligament. Measurements and Main Results. No ureteral injury occurred in patients whose cases were reviewed. There were, however, five bladder injuries (0.25%) and three nerve pareses (0.15%). Other minor complications, including fever, abscess or hematoma of the vaginal cuff, subcutaneous emphysema, and delayed vaginal cuff bleeding, occurred in less than 5% of patients. Conclusion. The technique proposed is simple and very effective in preventing ureteral injury during LAVH.