Incidental ureteral injury and repair during robotic-assisted total laparoscopic hysterectomy

Study objective: To show a surgical educational video in which an incidental ureteral injury was recognized intraoperatively and was repaired during robotic-assisted total hysterectomy for a very large uterus.

Design: Step-by-step demonstration of ureterolysis and repair of ureteral injury via a ureteroureterostomy technique using an educational video and schematic pictures.

Setting: Ureteral injuries are estimated to occur with a frequency of approximately 0.02% to 0.4% during laparoscopic hysterectomy. When compared with bladder injuries, ureteral injuries are much less likely to be recognized intraoperatively, and in some cases can be missed despite the use of intraoperative cystoscopy. The sequelae from ureteral injury are not insignificant, which can easily be prevented by intraoperative recognition and immediate repair. Minimally invasive surgery using the robotic system has led to a paradigm shift in the management of urinary tract injuries, which has been traditionally approached with open surgery.

Interventions: Robotic total hysterectomy and repair of incidental ureteral injury via ureteroureterostomy using standard end-to-end anastomosis technique and intracorporeal retrograde double J stent placement.

Conclusion: Robotic repair of ureteral injury during gynecologic surgery was associated with good outcomes, appeared safe and feasible, and saved the patient and the physician significant morbidity and medicolegal implications, respectively.