V12-05: Immediate evaluation and robot assisted repair of a urinary injury following a vaginal hysterectomy
Urinary injuries occur in approximately 0.33% of gynecologic laparoscopic procedures for benign indications . Of these, the majority are recognized intra-operatively and require surgical repair *Wong JMK, Bortoletto P, Tolentino J, Jung MJ, Milad MP. Urinary Tract Injury in Gynecologic Laparoscopy for Benign Indication: A Systematic Review. Obstet Gynecol. 2018;131(1):100-108.
A 48-year-old women sustained an injury to her trigone during a vaginal hysterectomy. The patient was transferred to our hospital where the injury was evaluated cystoscopically, radiographically and laparoscopically. The injury was repaired acutely in a laparoscopic, robot assisted fashion.
The accompanying video illustrates the following principles; #1: Appropriate evaluation of a urinary injury following gynecological surgery; #2: Separation and mobilization of the bladder and vaginal walls to allow a tension free closure; #3: Development of a peritoneal and omental flap to augment the repair; #4: The value of the robotic approach for precise visualization and suturing deep in the pelvis.
The accompanying video illustrates the principles for evaluation and repair of a urinary injury following hysterectomy and the advantages of a laparoscopic, robot assisted approach in an appropriately selected case.