Analysis of ureteral injuries for laparoscopic rectal cancer surgery. 2014

Xingmao Zhang, and Zheng Wang, and Haitao Zhou, and Jianwei Liang, and Zhixiang Zhou
Department of Gastrointestinal Surgery, Cancer Hospital , Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China .

Ureteral injury is one of the major complications for rectal surgery. However, few studies focused on ureteral injuries from laparoscopic rectal surgery have been reported. Characteristics of this kind of ureteral injuries and the related reasons are unclear. This study was designed to illustrate the characteristics of ureteral injuries during the procedure of laparoscopic rectal surgery and to analyze the related reasons. Of 1120 patients with rectal cancer who underwent laparoscopic surgery between July 2007 and July 2013, 11 cases had the complication of ureteral injuries. Data of these 11 patients were collected and analyzed retrospectively. In our study, the total incidence of ureteral injuries from laparoscopic rectal surgery was 0.98%, and left ureteral injuries were more common. Five cases of ureteral injuries occurred at the takeoff of the inferior mesenteric artery, 4 cases occurred at the small pelvic inlet, and 2 cases occurred at the location where the infundibulopelvic ligament crosses the pelvic brim. Four reasons accounted for the ureteral injuries: 5 cases resulted from massive ligation or cutting off without recognizing the anatomical structure, 3 cases resulted from unfamiliarity with normal anatomical structure under laparoscopy and unskilled laparoscopic operation, 2 cases resulted from an abnormal anatomical structure due to invasion of the tumor, and 1 case resulted from an unusual anatomical variation of ureter. It was easier to damage the left ureter during the procedure of laparoscopic rectal surgery. In conclusion, ureteral injuries usually occurred at three locations, and massive ligation or cutting off without recognizing the anatomical structure was the most common reason for laparoscopy-related ureteral injuries.

UI MeSH Term Description Entries
D008026 Ligation Application of a ligature to tie a vessel or strangulate a part. Ligature,Ligations,Ligatures
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010535 Laparoscopy A procedure in which a laparoscope (LAPAROSCOPES) is inserted through a small incision near the navel to examine the abdominal and pelvic organs in the PERITONEAL CAVITY. If appropriate, biopsy or surgery can be performed during laparoscopy. Celioscopy,Laparoscopic Surgical Procedures,Peritoneoscopy,Surgical Procedures, Laparoscopic,Laparoscopic Assisted Surgery,Laparoscopic Surgery,Laparoscopic Surgical Procedure,Procedure, Laparoscopic Surgical,Procedures, Laparoscopic Surgical,Surgery, Laparoscopic,Surgical Procedure, Laparoscopic,Celioscopies,Laparoscopic Assisted Surgeries,Laparoscopic Surgeries,Laparoscopies,Peritoneoscopies,Surgeries, Laparoscopic,Surgeries, Laparoscopic Assisted,Surgery, Laparoscopic Assisted
D012004 Rectal Neoplasms Tumors or cancer of the RECTUM. Cancer of Rectum,Rectal Cancer,Rectal Tumors,Cancer of the Rectum,Neoplasms, Rectal,Rectum Cancer,Rectum Neoplasms,Cancer, Rectal,Cancer, Rectum,Neoplasm, Rectal,Neoplasm, Rectum,Rectal Cancers,Rectal Neoplasm,Rectal Tumor,Rectum Cancers,Rectum Neoplasm,Tumor, Rectal
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective

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