Laparoscopic repair of a proximal ureteral injury during transperitoneal para-aortic lymphadenectomy: a video article.

Abstract

Ureteral injury during advanced gynecologic laparoscopic procedures is an uncommon but potentially serious complication, particularly during para-aortic lymphadenectomy performed for oncologic staging. We describe the laparoscopic management of a proximal right ureteral transection encountered during transperitoneal para-aortic lymphadenectomy in a 56-year-old woman (body mass index 36 kg/m2) with highrisk endometrial carcinoma. The injury was recognized intraoperatively and repaired using a tension-free ureteroureterostomy over a double-J stent. Key technical steps, including exposure in obese patients and preservation of ureteral vascularity, are demonstrated. This report highlights that timely intraoperative recognition and laparoscopic repair of proximal ureteral injury can prevent major morbidity and obviate open surgery, emphasizing the importance of advanced, minimally invasive surgical expertise.