Laparoscopic Dissection of the Pelvic Ureter: Rules of Engagement

Abstract

Study objective: To point out the relevant anatomy of the ureter and to demonstrate its rules of dissection.

Design: An educational video to explain how to use ureteral relevant anatomy and the principle of dissection to perform safe ureterolysis during laparoscopic procedures.

Setting: A tertiary care university hospital and endometriosis referential center.

Interventions: Anatomic keynotes of the ureter and examples of ureterolysis.

Conclusion: This video shows the feasibility of laparoscopic ureteral dissection and provides safety rules to perform ureterolysis. Identification and dissection of the ureter should be part of all gynecologic surgeons' background to reduce the risk of complications [1]. Knowledge of anatomy plays a pivotal role, allowing the surgeon to keep the ureter at a distance and minimizing the need for ureterolysis. Unfortunately, the need for ureteral dissection is not always predictable preoperatively, and gynecologic surgeons need to master this technique, especially when approaching more complex procedures such as endometriosis [2]. An implicit risk of damage cannot be denied when performing ureterolysis; therefore, the ureter should be dissected only when strictly necessary and handled with care to minimize the use of energy [3].

Keywords: Dissection; Endometriosis; Ureteral anatomy; Ureterolysis.