Ureteral complications after gasless laparoscopic hysterectomy

Laparoscopic hysterectomy is becoming a more common operation. Gasless lapa roscopy initially seems to be a better technique, reducing CO, complication s and allowing the use of conventional instruments rather than more expensi ve laparoscopic tools. We report our experience with 50 cases of laparoscop ic hysterectomies, 5 of which were performed using a gasless technique. Of these five cases, there were two cases of ureteral stenosis. Ureteral injur ies are common with hysterectomy, even in nonlaparoscopic procedures, and t he literature is replete with recommendations to avoid this damage. In the gasless procedure, the ureters cannot be repositioned completely from the c ervix after the hydrodissection. Extreme caution must be taken when applyin g bipolar or monopolar energy. The abdominal cavity shape does not allow co mplete avoidance of the ureters using the gasless technique. We have decide d not to use a gasless technique with hysterectomy. We believe that the act ual complication rate may be higher than reported, due to investigators' re luctance to report such complications. Our hope is that this report will en courage other investigators to help establish a more accurate rate of possi ble complications associated with this procedure.