IDENTIFICATION OF THE URETER AND DISSECTION OF THE BLADDER PILLAR IN LAPAROSCOPIC-ASSISTED RADICAL VAGINAL HYSTERECTOMY

Background: Identification of the ureter and transection of the bladde r pillar are the hallmarks of radical vaginal hysterectomy. Technique: First, the supraureteral part of the bladder pillar is transected lap aroscopically. After identification of the ureter by the ''click'' man euver, the infraureteral part of the bladder pillar is transected vagi nally. Then, the rest of the supraureteral part of the bladder pillar is exposed by eversion of the uterine fundus and transected vaginally. Experience: Between August 1994 and May 1997, 71 women were treated c onsecutively for cervical cancer stages IA2-IVB. Our new technique was performed in 16 women and compared with 55 patients in whom tradition al techniques were used. Intraoperative and postoperative data were re corded prospectively. The duration of the vaginal phase of the operati on was shortened significantly with our new technique compared with tr aditional techniques. There was no significant difference in intraoper ative and postoperative injuries to the bladder or to the ureter for t he various techniques. Conclusion: Our technique of identification of the ureter and dissection of the bladder pillar may prove a valid alte rnative to the traditional techniques, with statistically significant time gain.