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

Abstract

Objective

The technique for freeing the ureter in the endoscopic treatment of deeply infiltrating endometriosis (DIE).

Methods

One hundred and forty-nine patients with complete obliteration of the cul-de-sac submitted to laparoscopic dissection of the ureter using ultrasonically activated shears, were retrospectively evaluated. Surgical technique, operative time and morbidity were analyzed.

Results

Two hundred and ninety-nine ureters were dissected in 149 patients affected by endometriosis of the posterior compartment. The average time to unroof the ureter on one side was 16 min. In three cases the ureter was damaged and promptly repaired without ureteronephrosis with a further 18-month radiographic control.

Conclusions

An important step in laparoscopic surgical treatment of DIE obliterating cul-de-sac, is dissection of the ureter at its crossing with the uterine artery, to avoid ureteral damage. In this paper, we describe a feasible and safe technique for ureteral dissection in DIE with the use of ultrasonic energy, even with rectal involvement.

The use of ultrasonic energy reduces potential complications related to electrical energy.