Akusherstvo i ginekologiia · 2013
[Areas of risk for ureteral lesion during radical hysterectomy].
Аннотация на английскомСтатьяНазвание и аннотация: Перевод в очереди
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Tanchev L, Gortchev G, Tomov S, Khinkova N, Tzvetanova K
Аннотация
INTRODUCTION: The close interrelations of the pelvic ureter with surrounding structures and organs are a prerequisite for complications during surgical interventions in the lesser pelvis.
OBJECTIVE: Exploration and visualization of the areas of risk for lesion of pelvic ureter during minimally invasive radical hysterectomy.
RESULTS: Based on our observations and the available literature, we identified the following areas and steps of the radical hysterectomy as risky: at the entrance in the lesser pelvis, upon ligation of the infundibulopelvic ligament; incision of the back leaf of broad ligament of the uterus; dissection of the pararectal space; ligation of the uterine artery; dissection of the fourth space and transection of the vesicouterine ligaments; transection of the sacrouterine ligaments; incision of the anterior vaginal wall. We registered one uretero-vaginal fistula in a total of 133 patients on the eighth postoperative day. The lesion was identified in area of the distal portion of ureter.
CONCLUSION: Knowledge about the ureter location, its interrelations with surrounding structures, and its blood supply, combined with capable surgical techniques, would contribute to reduction of the incidence of complications.
OBJECTIVE: Exploration and visualization of the areas of risk for lesion of pelvic ureter during minimally invasive radical hysterectomy.
RESULTS: Based on our observations and the available literature, we identified the following areas and steps of the radical hysterectomy as risky: at the entrance in the lesser pelvis, upon ligation of the infundibulopelvic ligament; incision of the back leaf of broad ligament of the uterus; dissection of the pararectal space; ligation of the uterine artery; dissection of the fourth space and transection of the vesicouterine ligaments; transection of the sacrouterine ligaments; incision of the anterior vaginal wall. We registered one uretero-vaginal fistula in a total of 133 patients on the eighth postoperative day. The lesion was identified in area of the distal portion of ureter.
CONCLUSION: Knowledge about the ureter location, its interrelations with surrounding structures, and its blood supply, combined with capable surgical techniques, would contribute to reduction of the incidence of complications.