Laparoscopic Dissection of the Ureter in Deep-Infiltrating Endometriosis (DIE) of the Pelvis using Ultrasonically Activated Shears

Laparoscopic Access with Optical Gasless Trocar: A Single-center Experience of 7431 Procedures

STUDY OBJECTIVE

To analyze the complications experienced and describe laparoscopic surgery using a gasless optical trocar.

DESIGN

A retrospective study.

SETTING

A department of obstetrics and gynecology in a tertiary center in Italy.

PATIENTS

Seven thousand four hundred thirty-one surgical procedures were performed.

INTERVENTIONS

From the hospital database, data were evaluated regarding major complications of laparoscopy with the ENDOPATH XCEL Bladeless Trocar (Ethicon, Johnson & Johnson, Somerville, NJ) performed between 2000 and 2017 by different laparoscopic surgeons.

MEASUREMENTS AND MAIN RESULTS

The mean age of the patients was 40.66 ± 12.06 years (range, 13-91 years). The mean body mass index was 22.12 ± 3.64 kg/m² (range, 15.74-41.51 kg/m²). The overall complication rate was 0.31% (23/7431 cases). Major complications included stomach perforation in 1 procedure (0.014%), ileal perforation in 2 procedures (0.028%), and blood vessel perforation in 1 procedure (0.014%). Twelve procedures were completed with initial access through the omentum and 2 through an ovarian cyst. In 5 procedures (0.067%), conversion to laparotomy was required because the optical trocar failed to reach the abdominal cavity. With regard to complications requiring further intervention (n = 9), the rate of complications was 0.12%.

CONCLUSIONS

The optical gasless trocar is a feasible laparoscopic entry technique. The complication rate is lower than those reported previously.

Parametrial endometriosis with ureteral involvement: A case report of a conservative approach without ureteral resection

Introduction:

Parametrial endometriosis could often involve the ureter and periureteral tissue causing hydronephrosis and distortion of the normal ureteral course and position. The treatment in the case of hydronephrosis could be ureterolysis (with or without the positioning of a stent) or a ureteral resection.

Materials and methods:

This is the case of left parametrial endometriosis with hydronephrosis in a young woman. The preoperative work-up showed a deep infiltrating endometriosis of the left parametria, the left uterosacral ligament, and the left ureter which caused hydronephrosis. The patient was symptomatic (dysmenorrhea, dysuria, and pelvic pain). In this video, we focused on ureterolysis: all the endometriotic tissues were removed, the ureter was completely released, and the decision was to place a stent in the ureter without ureteral resection.

Results:

The post-operative course was normal, the stent was changed after 1 week (from mono-J to double-J) and removed 1 month after surgery. Follow-up at 3 and 8 months after stent removal was normal, and renal function was normal. The last follow-up, after 13 months, showed no hydronephrosis, no signs of deep infiltrating endometriosis, and normal renal function. The patient continues with oral contraception.

Conclusion:

Ureterolysis could be an effective alternative to ureteral resection in cases of deep infiltrating endometriosis even when the ureter is involved with hydronephrosis.