Our Summary

This research paper is about injuries to the ureter, a tube that carries urine from the kidney to the bladder, which can occur during colorectal surgeries. These injuries, while rare, can lead to serious health problems, longer hospital stays, and higher costs.

The paper discusses how laparoscopic surgery, which is a minimally invasive procedure, is becoming more popular for colorectal surgery. However, this type of surgery may increase the risk of injuring the ureter, particularly during certain procedures.

To avoid these injuries, surgeons have improved their techniques over time. In difficult cases, they may use tools like preoperative ureteral stenting, which involves inserting a tube into the ureter to keep it open. Lighted stents, which are easier to see during surgery, have also been developed.

However, these methods also come with risks and their benefits are still being debated. To better see the ureter during surgery, new technologies such as augmented reality, near-infrared fluorescence, and hyperspectral imaging are being developed and tested. Early results show promise in helping surgeons better identify and protect the ureters, but there are still technical issues to be resolved.

The paper reviews current methods for identifying the ureters during surgery and preventing injury, as well as exploring future trends in this area.

FAQs

  1. What are the potential risks associated with laparoscopic colorectal surgery?
  2. What techniques and tools are currently being used by surgeons to prevent ureter injuries during colorectal surgeries?
  3. What new technologies are being explored to better identify the ureters during surgery and prevent injury?

Doctor’s Tip

A helpful tip a doctor might tell a patient about colorectal surgery is to discuss with their surgeon the steps being taken to protect the ureter during the procedure. It’s important for patients to be informed and to understand the potential risks involved in order to make the best decisions for their health. They should also ask about any new technologies or techniques being used to improve the safety of the surgery. By being proactive and asking questions, patients can feel more confident and prepared for their procedure.

Suitable For

Patients who are typically recommended colorectal surgery include those with conditions such as colorectal cancer, inflammatory bowel disease, diverticulitis, and severe hemorrhoids. Additionally, patients with complications such as bowel obstructions, fistulas, or strictures may also require colorectal surgery. Patients who have not responded to conservative treatments or who are at high risk of developing complications may also be recommended for surgery.

It is important for surgeons to carefully assess each patient and their individual risk factors before recommending colorectal surgery. Patients with a history of ureteral injury or other urological issues may be at higher risk for complications during surgery, and special precautions may need to be taken to protect the ureters.

Overall, the goal of colorectal surgery is to improve the patient’s quality of life and reduce their risk of complications. By carefully selecting appropriate patients for surgery and taking steps to prevent injuries such as ureteral damage, surgeons can help ensure successful outcomes for their patients.

Timeline

Before colorectal surgery:

  1. Patient undergoes initial consultation with surgeon to discuss surgery options and risks.
  2. Patient may need to undergo preoperative testing, such as blood work and imaging scans.
  3. Patient may need to follow a special diet or stop certain medications in preparation for surgery.

During colorectal surgery:

  1. Surgeon carefully identifies and protects the ureter to avoid injury during the procedure.
  2. In some cases, surgeon may use tools like preoperative ureteral stenting to help protect the ureter during surgery.
  3. New technologies like augmented reality and near-infrared fluorescence may be used to better visualize the ureter during surgery.

After colorectal surgery:

  1. Patient is monitored closely for any signs of ureter injury, such as pain or difficulty urinating.
  2. Patient may need to stay in the hospital for a few days to recover from surgery.
  3. Patient may need to follow a special diet or take medications to aid in their recovery.
  4. Patient may need to follow up with their surgeon for postoperative care and monitoring.

Overall, the timeline of a patient’s experience before and after colorectal surgery involves thorough preparation, careful surgery techniques to prevent ureter injury, and close monitoring and follow-up care to ensure a successful recovery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about colorectal surgery, specifically regarding potential ureter injury, include:

  1. What are the risks of ureter injury during colorectal surgery?
  2. How will you ensure that my ureter is protected during the procedure?
  3. Have you had experience with laparoscopic surgery, and what measures do you take to reduce the risk of ureter injury?
  4. Will you be using any advanced technologies or techniques to better visualize and protect my ureter during surgery?
  5. What are the potential complications associated with ureteral stenting or other preventive measures?
  6. How will you monitor for any signs of ureter injury post-surgery?
  7. What is your experience with managing and treating ureter injuries if they were to occur?
  8. Are there any specific symptoms I should watch out for that may indicate a ureter injury post-surgery?
  9. How will you ensure that I receive appropriate follow-up care to monitor for any potential ureter complications?
  10. Can you provide me with any additional information or resources about ureter injuries and their prevention during colorectal surgery?

Reference

Authors: Douissard J, Ris F, Morel P, Buchs NC. Journal: Surg Technol Int. 2018 Jun 1;32:119-124. PMID: 29791695