Laparoscopic Hysterectomy After Childhood Ureteral Reimplantation

Abstract

Study Objective

Demonstrate the surgical technique of laparoscopic hysterectomy and bilateral salpingectomy with abnormal ureteral anatomy after prior ureteral surgery.

Design

Stepwise narrated video footage of laparoscopic surgery.

Setting

Tertiary care hospital affiliated with an academic institution.

Patients or Participants

This case describes a 33-year-old gravida 0 cisgender woman with a history of left ureteral reimplantation with dysmenorrhea desiring definitive surgical management.

Interventions

A laparoscopic survey of the abdomen and pelvis demonstrated an ectopic left ureter that entered the peritoneum at the level of the infundibulopelvic ligament, traversed along the ovarian vasculature, crossed over the fallopian tube and round ligament, then coursed lateral and anterior to the cervix to insert into the bladder in the normal anatomic location. The laparoscopic hysterectomy and bilateral salpingectomy were then performed with meticulous dissection of the left ureter to prevent ureteral injury. Routine cystoscopy demonstrated normal bilateral ureteral orificies.

Measurements and Main Results

The patient's surgery was uncomplicated with no immediate or delayed ureteral injury. Ureteral anatomy and techniques to avoid ureteral injury were reviewed including routine identification and re-identification of the ureters, identification of preoperative risk factors, and consideration of intraoperative urology consultation if suspicion of injury.

Conclusion

In this video, we demonstrate a step-wise laparoscopic hysterectomy and bilateral salpingectomy in a patient with abnormal left ureteral anatomy.