Study Objective: To introduce a surgical technique to minimize the chance of ureteral injury during laparoscopic-assisted vaginal hysterectomy (LAVH).
Design: Retrospective case review (Canadian Task Force classification II-3).
Setting: Show Chwan Memorial Hospital, Changhua, Taiwan.
Patients: Two thousand and six women who underwent LAVH between January 1992 and June 2001.
Intervention: A simple step of creating a "window" over the anterior and posterior broad ligaments to push inferolaterally the areolar tissue (in which the ureter is embedded) on the posterior broad ligament.
Measurements And Main Results: No ureteral injury occurred in patients whose cases were reviewed. There were, however, five bladder injuries (0.25%) and three nerve pareses (0.15%). Other minor complications, including fever, abscess or hematoma of the vaginal cuff, subcutaneous emphysema, and delayed vaginal cuff bleeding, occurred in less than 5% of patients.
Conclusion: The technique proposed is simple and very effective in preventing ureteral injury during LAVH.
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