The Distance between Ureter and Cervix in a Retrograde Hysterectomy Technique: Combination of Anurach Uterine Manipulator and Colpotomy for avoiding Ureteral Injury during Total Laparoscopic Hysterectomy
Chamnan Tanprasertkul MD, PhD*, Anurach Kulvanitchaiyanunt MD**
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand ** Department of Obstetrics and Gynecology, Pranangklao Hospital, Nonthaburi, Thailand
Objective : To measure the distance between the ureter and the cervix (UCD) when using a retrograde hysterectomy technique
with combination of Anurach uterine manipulator (AUM) and colpotomy to minimize ureteral injury.
Material and Method: Twenty participants, mean age of 39.8 years who underwent total laparoscopic hysterectomy (TLH)
during January 2016 and June 2016 at our institution, gave their consents and were enrolled. The combination of AUM and
colpotomy in a retrograde technique was used, and the UCD measured before and after applying pressure. Real time
fluoroscopy was used to identify and measure the between the lateral cervicovaginal angle and the ureteral catheters in each
patient. Kidney-ureter-bladder (KUB) ultrasonograms were evaluated at 48 hours, one week and one month following the
surgery in every case.
Results : All procedures were successfully completed without major complications or conversion. The average time of surgery
was 113.40 minutes. The range of distances before applying pressure (pre_UCD) on both sides was 1.50 to 1.8 cm with the
mean distances of 1.62 cm and 1.63 cm on the left and right sides, respectively. Following this technique, the total distance
(post_UCD) was demonstrated in the range of 3.0 to 3.6 cm. The mean increases in the distances (increase_UCD) were 1.50
and 1.58 cm on the left and right sides, respectively. There was no abnormalities of KUB ultrasonograms including the signs
and symptoms of urinary complications after operation through one month of follow-up.
Conclusion : With this technique, the surgeons could expect a safer distance of operative area. In the first series of patients,
data demonstrated the safety and the benefit of this technique during TLH in decreasing the incidence of ureteral injury.
However, evaluation in a larger variety of patients is warranted.
Keywords : Laparoscopic hysterectomy, Ureteral injury, Colpotomy, Ureter to cervix distance
