Step-wise Technical Description of Performing Ureteric Tunnel Dissection in Laparoscopic Radical Hysterectomy

Abstract

Objectives: Technical description of performing ureteric tunnel dissection in laparoscopic radical hysterectomy (LRH) surgery. Materials and Methods: This is a retrospective analysis. A total of 91 patients of the International Federation of Gynaecology and Obstetrics Stage IA2, IB1, and IB2 of cervical cancer were operated by the same surgeon between January 2015 and December 2019 were analyzed. Results: The median time for one side ureteric tunnel dissection was 3 min 15 s (range 2 min 35 s– 6 min 18 s). None of the cases were converted to laparotomy. The patients' median hospital stay was 2 days (range 1–4 days). There were no short-term or long-term complications related to ureteric tunnel dissection. Conclusion: This analysis explains the descriptive methodology of operative technique, especially for ureteric tunnel dissection in LRH. This technique is easily reproducible and replicable, with chances of marginal or negligible complication rates.

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“…This step further helps in the lateralization of ureters, proper identification of inferior hypogastric nerve (IHN), and thus facilitating nerve-sparing surgery. Ureterolysis and Ureter tunnel dissection 15 The ureter is identified in the medial fold of the broad ligament and separated from its medial peritoneal attachment. This dissection is continued in a craniocaudal direction till the uterosacral ligament.…”

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“…Ureteric tunnel dissection is executed with complete lateralization of the bilateral ureter till its entry into the bladder along with sparing of the inferior hypogastric nerve and its plexus and its associated branch to the bladder. 11 Laterally, commonly the nerve lies in lateral parametria and divides into two branches, one goes towards the uterus and the other follows along with the ureter culminating at its entry into the bladder in Yabuki space. Nerve supply to the uterus is invariably sacrificed in all cases.…”

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“…[ 1 ] Currently, the laparoscopic technique is increasingly being utilized in performing simple and complex gynecologic procedures for various benign and malignant gynecologic conditions. [ 2 3 4 5 6 7 8 ]…”