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Standardization of laparoscopic extrafascial hysterectomy: anatomic considerations to protect the ureter

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Abstract

Purpose

To describe the procedure of laparoscopic extrafascial hysterectomy to avoid ureter injury.

Methods

Data were obtained from: (1) anatomic study of ten fresh female cadavers to measure the distance between the point where the ureter and uterine artery cross and the level of section of the ascending branch of the uterine artery during extrafascial dissection of the uterine pedicle and uterosacral ligament (Paris School of Surgery). The Wilcoxon test was used to compare measurements within each subject. P < 0.05 was considered to denote significance; (2) prospectively collected clinical data from women undergoing laparoscopic extrafascial hysterectomy from July 2006 to March 2014 at Poissy University Hospital, to describe the laparoscopic extrafascial hysterectomy technique with analysis of surgical complications using the Clavien–Dindo classification.

Results

Anatomic study: The mean (SD) distance between the point where the ureter and uterine artery cross and the level of the section of the ascending branch of the uterine artery were: 11.6 mm (5.2) in neutral position and 25 mm (7.5) after pulling the uterus laterally; and 25mm (8.9) after sectioning the ascending portion of the uterine pedicle and 38.6 mm (4.5) after complete uterine artery pedicle dissection through the uterosacral ligaments. After release of the ureter, the curve in front of the uterine artery disappeared.

Clinical laparoscopic study: Sixty-eight patients underwent laparoscopic extrafascial hysterectomy. No ureteral complications occurred.

Conclusion

Laparoscopic extrafascial hysterectomy is a safe and feasible procedure. Combined lateralization and elevation of the uterus, section of the ascending branch of the uterine artery, and its extrafascial dissection along the uterosacral ligament contribute to protecting the ureter during the procedure.

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Acknowledgements

This work has been done at: Ecole de Chirurgie de l'AP-HP, 7 rue du fer à Moulin, 75005 Paris.

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Authors and Affiliations

  1. Département de Gynécologie-Obstétrique, Hôpital Universitaire de Rennes, Université de Rennes 1, Rennes, France

    Krystel Nyangoh Timoh & Vincent Lavoué

  2. Laboratoire D’Anatomie, Faculté de Médecine, Avenue du Professeur Léon-Bernard, Rennes Cedex, France

    Krystel Nyangoh Timoh

  3. Department of Obstetrics and Gynaecology and Reproductive Medicine, Université Saint-Quentin-en-Yvelines, Hôpital de Poissy, 10 r Champ Gaillard, 78300, Poissy, France

    Caroline Paquet & Arnaud Fauconnier

  4. Department of Obstetrics and Gynaecology, Hôpital Intercommunal de Créteil, Université Paris Est, UPEC-Paris XII, 12 Avenue de Verdun, 94000, Créteil, France

    Cyril Touboul

  5. Department of Gynaecology, Obstetrics and Reproductive Medicine, CHI Poissy–St-Germain, 10 Rue du Champ Gaillard, 78103, Poissy, France

    Arnaud Fauconnier

Authors
  1. Krystel Nyangoh Timoh
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  2. Caroline Paquet
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  3. Vincent Lavoué
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  4. Cyril Touboul
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  5. Arnaud Fauconnier
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Contributions

The last author, AF, designed the study. The first author, KNT, collected the data and analyzed all the data and participated in drafting the article. CP collected and analyzed all the data. VL, CT, and AF participated in drafting and approving the article.

Corresponding author

Correspondence to Arnaud Fauconnier.

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Nyangoh Timoh, K., Paquet, C., Lavoué, V. et al. Standardization of laparoscopic extrafascial hysterectomy: anatomic considerations to protect the ureter. Surg Radiol Anat 41, 859–867 (2019). https://doi.org/10.1007/s00276-019-02242-7

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  • DOI: https://doi.org/10.1007/s00276-019-02242-7

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