Our Summary

This research paper discusses injuries to the ureters, the tubes that carry urine from the kidneys to the bladder, during laparoscopic hysterectomies. These are surgeries where the uterus is removed through small incisions in the abdomen, using a special camera to guide the surgeon. This method is often preferred because it allows for a quicker recovery and shorter hospital stay, with less risk of complications. However, in less than 1% of cases, the ureters can be accidentally damaged.

The paper notes that these injuries can sometimes be identified while the surgery is being performed, but often they are not noticed until much later, when the patient experiences non-specific symptoms. It uses three case studies of laparoscopic hysterectomies to describe the different symptoms that might suggest a ureter injury. It also discusses different ways to diagnose and repair these injuries.

The authors conclude that all complications following a laparoscopic hysterectomy should be thoroughly investigated, and doctors should consider the possibility of a ureter injury if a patient’s recovery is not going as expected.

FAQs

  1. What are the benefits of using minimally invasive laparoscopic techniques in gynecologic surgery?
  2. What are the chances of ureteric injuries occurring during laparoscopic hysterectomies and when do they usually manifest?
  3. How are complications like ureteral injury diagnosed and treated after a laparoscopic hysterectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about laparoscopic hysterectomy is to be aware of signs and symptoms of potential ureteric injury, such as abdominal pain, fever, urinary tract infections, or abnormal urine output. It is important to report any unusual symptoms to your healthcare provider promptly to ensure timely diagnosis and treatment.

Suitable For

Patients who are typically recommended for laparoscopic hysterectomy include those with the following conditions:

  • Benign gynecological conditions such as fibroids, endometriosis, adenomyosis, or abnormal uterine bleeding
  • Early-stage gynecological cancers such as cervical, uterine, or ovarian cancer
  • Patients who desire a minimally invasive surgical approach with quicker recovery time and shorter hospital stay
  • Patients with a lower risk of complications such as obesity, diabetes, or cardiovascular disease
  • Patients who have already tried other treatments such as medication or less invasive procedures without success.

Timeline

Before laparoscopic hysterectomy:

  • Patient consultation with gynecologist to discuss options for hysterectomy
  • Pre-operative tests and evaluations to ensure patient is a good candidate for surgery
  • Patient education about the procedure, risks, and recovery process
  • Pre-operative preparation such as fasting and skin preparation

During laparoscopic hysterectomy:

  • Patient is under general anesthesia
  • Surgeon makes small incisions in the abdomen to insert a laparoscope and other surgical instruments
  • Uterus and other reproductive organs are removed
  • Surgery typically lasts 1-2 hours
  • Surgeon checks for any complications such as ureteric injury during the procedure

After laparoscopic hysterectomy:

  • Patient is monitored in recovery room before being discharged home
  • Patient may experience pain, bloating, and fatigue in the days following surgery
  • Follow-up appointments with surgeon to monitor recovery and address any concerns
  • Most patients are able to resume normal activities within 2-6 weeks
  • Long-term follow-up to monitor for any complications or side effects from the surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a laparoscopic hysterectomy, including the risk of ureteric injury?
  2. How will the doctor ensure that the ureters are protected during the surgery?
  3. What symptoms should I watch out for that could indicate a ureteric injury after the surgery?
  4. How will a ureteric injury be diagnosed and treated if it occurs during the laparoscopic hysterectomy?
  5. What is the doctor’s experience and success rate with laparoscopic hysterectomies and avoiding ureteric injuries?

Reference

Authors: Monist MJ, Skorupski P, Warda P, Buraczynski P, Kolodynska A, Semczuk A. Journal: Ginekol Pol. 2022;93(7):585-590. doi: 10.5603/GP.a2022.0028. Epub 2022 Jul 27. PMID: 35894493