ULTRASONOGRAPHY OF THE URETER DURING LAPAROSCOPIC GYNECOLOGICAL SURGERY

The purpose of this study was to evaluate the ultrasonographic appeara nce and normal function of the ureter during gynecological surgery. Th e study group consisted of 14 gynecological patients scheduled for lap aroscopy and 12 patients scheduled for laparotomy. Under standardized anesthesia conditions before pelvic surgery, the appearance, location, dimensions and peristaltic activity of the ureter were examined using a 7.5-MHz flexible laparoscopic linear transducer probe. Imaging of t he ureter was possible in all cases. The ureteral lumen, mucosa, sub-e pithelial connective tissue and muscular layer could be imaged as a tu bular structure with low-level echoes. The separate layers, however, c ould not be differentiated by ultrasonography. The ureteral diameters at resting phase did not differ between the open surgery and laparosco py groups. During peristaltic activity the maximal diameter was smalle r in the laparoscopy group. The mean number of peristaltic waves was 2 3 +/- 7 waves per 5 min and this did not differ significantly between the open and laparoscopic surgery groups. Intermittent periods of retr ograde flow were detected in 21 of the 26 patients. As seen in this st udy, ureteral location and function can be ultrasonographically evalua ted during surgery and laparoscopic conditions do not have much influe nce on the ureter. The role of laparoscopic ultrasonography in lowerin g the incidence of ureteral complications gynecological surgery needs further study.