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Ureteral thermal injury

Ureteral injury is one of the possible complications of gynecologic surgery. Ureteral dissection can cause a mechanical and sometimes a thermal damage to the ureteral wall. The thermal injury is usually the worst scenario: the lesion can in fact lead not only to a direct burning of the ureter but, most of the time, to an ischemic damage of the vascular bundle that envelops the ureter with consequent necrosis of the ureteral wall. This video shows the case of a young patient who underwent a laparoscopic gynecologic operation made in another hospital. The surgeon used the monopolar current at the level of the posterior leaf of the broad ligament. In the first postoperative day, the patient conditions worsened presenting abdominal pain, a little increase in CRP, an increase in creatinine levels and left hydronephrosis Because of no improvement in the patient conditions, it was decided to perform an emergency diagnostic laparoscopy. We found filmy adhesions and a complete ureteral necrosis to a depth of 4 centimeters Thereafter a cystoscopy was performed and we tried to place a double J ureteral stent without result. In keeping with our urologist we performed a mini laparotomy for ureteral reimplantation The post-operative period was uneventful and the double J stent was removed after 60 days.