Laparoscopic Primary Repair of Distal Ureter Injury During Bilateral Oophrectomy

Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252 group included 29 patients in whom the ICS was used, and the non-ICS group which included 34 patients. Both groups were similar except for: pre surgical anemic status; [51 % in the ICS group vs. 26% in the nonICS group (p 0,04)] and intramural myoma size; there were bigger myomas in the ICS group [74 mm vs 55 mm (p: 0,036)] Intraoperatory outcomes were similar in both groups. In the ICS group an average of 394 ml of red cell concentration was reinfundied during surgery. There were no differences on postoperative outcomes. No complications related with the ICS were registered. There were no differences in iron infusion and red blood cell transfusion between groups. Conclusion: It is not uncommon that patients with uterine fibroids are anemic at time of surgery because of symptoms caused by the myomas. We know that this type of procedure might have an important blood loss which can required transfusion. In spite of ICS group patient were more anemic and had bigger myomas, there were no differences between the groups in terms of iron infusion and transfusion rates. ICS can be consider for patients with higher risk of intraoperative blood loss, specially for those who refused heterologous transfusions. 718 D50%: A Crystal Clear Vision During Intraoperative Cystoscopy Rivero J,1 Bosque V,1 Alicyoy A,1 Patricia Y,1 Carugno J.2 1Minimally Invasive Gynecology, Centro Clinico Docente La Trinidad, Caracas, Distrito Federal, Venezuela; 2Obstetrics and Gynecology, University of Miami, Miami, Florida Study Objective: To describe our experience using 50% dextrose as distention media during cystoscopy for assessment of ureteric patency. Design: Case series study. Setting: Advanced laparoscopy and pelvic floor reconstruction fellowship program. Patients: 69 consecutive patients who underwent vaginal, laparoscopic or abdominal hysterectomy and related procedures. Intervention: Patients who underwent hysterectomy from 3 different routes were identified. At the end of the procedure, a solution of 100 cc of D50% plus 300 cc of normal saline (NS)was placed into the bladder through the indwelling catheter, at the same time, all patients received furosemide 20 mg IV given by the anesthesiologist. The catheter was removed and cystoscopy was performed. If the ureteral jet was not visualized, indigo carmin was given IV to change the color of the urine. Measurements and Main Results: We were able to visualize ureteral jets in 68 patients 99.2 % of the time (137 ureters). There was one case in which the left ureter jet was not seen. The ureter was then inspected laparoscopically and was noted kinked by a close stitch that was placed in the left utero-sacral ligament. After removal of the stitch the left ureter jet was soon visualized on repeated cystoscopy. We encountered no complications as a result of using D50% as distention media. Conclusion: We conclude that D50% should be considered as an effective alternative to improve visualization of ureteric jets during intraoperative cystoscopy. 719 Laparoscopic Primary Repair of Distal Ureter Injury During Bilateral Oophrectomy Choi H-J,1 Paik ES,1 Choi CH,1 Shim M-H,1 Kim T-J,1 Kim W-Y,1 Kang H,2 Kim B-G,1 Bae D-S.1 1Obstetrics and Gynecology, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; 2Obstetrics and Gynecology, Daerim St. Mary’s Hospital, Seoul, Korea Study Objective: To show the case of laparoscopic primary repair of distal ureter injury during bilateral oophorectomy. Design: We demonstrate step by step procedure of laparoscopic ureteroureterostomy technique.

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Setting: The patient was 61 years old with BRCA1 mutation. A 12mm trocar was placed at left lower quadrant. Three 5mm trocars were placed at right lower quadrant, subumbilicus, and suprapubic area. Patients: She underwent a surgery due to ovarian cyst rupture, but she didn’t know which organ was removed. She also undertook open adhesiolysis due to bowel obstruction immediately after previous surgery. To make a decision for surgical procedure, magnetic resonance imaging (MRI) was performed. In MRI, left ovary with 0.5cm-sized simple cyst, right ovary, and subtotal hysterectomy status were found.To show the case of laparoscopic primary repair of distal ureter injury during bilateral oophorectomy. As expected, severe abdominal adhesions were found. Adhesiolysis and left oophorectomy was followed by right pelvic wall exploration with retroperitoneal approach. During identification of right infundibulo-pelvic ligament, the right ureter was transected obliquely by laparoscopic scissors without thermal injury. Intervention: Although traditional management of ureter injury was open surgery, we decided to perform a laparoscopic repair with delayed absorbable suture. Foley catheter was inserted because intraoperative retrograde pyelogram showed minimal leakage at the low pressure after completion of repair. Measurements and Main Results: Laparoscopic repair of ureteral injury during gynecologic surgery was performed successfully. CT urography showed neither leakage nor obstruction at 2 weeks of repair. Conclusion: Traditional open ureteroureterostomy could be substituted by laparoscopic repair.