Prevention of ureteral injury in difficult laparoscopic dissection via infrared ureteral stents

This video demonstrates the usefulness of infrared ureteric stents during rectal or colonic resection when there is unusual dense adhesions or mass involving the lateral pelvic wall. In this case, the patient is having a rectal resection due to severe endometriosis and there were dense adhesions between the rectum, uterus and the pelvic wall. The presence of the infrared stents visible by the 3-chip camera allowed the surgeon to mobilize the rectum off the pelvic wall and the uterus without fear of damage to the ureter, which was close by but well outlined.

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Prevention   of   ureteral   injury   in   difficult   laparoscopic   dissection   via   infrared   ureteral   stents

Authors
J Leroy, J Marescaux
Abstract
This video demonstrates the usefulness of infrared ureteric stents during rectal or colonic resection when there is unusual dense adhesions or mass involving the lateral pelvic wall. In this case, the patient is having a rectal resection due to severe endometriosis and there were dense adhesions between the rectum, uterus and the pelvic wall. The presence of the infrared stents visible by the 3-chip camera allowed the surgeon to mobilize the rectum off the pelvic wall and the uterus without fear of damage to the ureter, which was close by but well outlined.
Classification
basic techniques
Keywords
ureteric stent, infrared, gynecology,operation,rectum,endometriosis
Media type
Duration
05'00''
Publication
2002-12
Popular
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Audio
en
Subtitles
en
E-publication
WeBSurg.com, Dec 2002;2(12).
URL: http://www.websurg.com/doi-vd01en1241e.htm

Prevention   of   ureteral   injury   in   difficult   laparoscopic   dissection   via   infrared   ureteral   stents

1. Case presentation 00'19''
Ureteral injuries account for significant annual morbidity and several methods have been devised to try and diminish this morbidity. Shown here is an infrared ureteral illuminated stent system that is visible only via the infrared camera. As seen with the naked eye, there is no illumination. However through the camera, you can see clearly illumination. Infrared stents can be used even in high light conditions such as laparoscopy and having the full length of ureters illuminated allows time savings by rapid localization of the ureters. We have here a young female patient who has undergone repeated operative procedures for a significant endometriosis. She’s undergoing at this point an anticipated rectal resection for a recurrent disease on the anterior rectal wall. Because of her prior surgery, she has significant scar tissue postoperative adhesions in the regions of her previous endometriosis. You see here the adhesions against the ureter. With the illuminated stents only the distal 20cm of the stent are illuminated. They can be positioned exactly such that they encompass the area of dissection as is seen here. We’ve just pulled back the stent to the left and on the right, this stent is now into position. This allows for safe dissection immediately adjacent to the ureter without having worries that it will be injured during the dissection. You see here the ureter as it goes through the retroperitoneal plane under the course of the sigmoid colon. We also see here the right ureter as it is immediately adjacent to the rectal wall. The ureters do not need to be dissected to be demonstrated in this: the likelihood of devascularization and direct injury is significantly decreased. Drawbacks to the traditional illuminated stent included potential injury to the ureters by manipulation and placement, heat transmission injury to the edge epithelium and most importantly in this case, difficulty with visualization of laparoscopic setting from optical washout. As you can see, we’re not having that problem in this case. Further advantages of this technology include ability to be clearly visualized through up to 3cm of tissue and you can see now the rectum being pulled free from the left ureter even in this very tight space. The surgeon can continue to proceed without fear of injuring the ureter. Additionally this system uses a sonic probe, which can detect the infrared light as is demonstrated here through the colon itself. The sound beat can register the presence of the infrared light even when it’s not visible on this special infrared camera. We’re getting a sound registry through all of this portion of the colon as the probe becomes more and more proximal to the stent. Dissection of the colonic mesentery free from the retroperitoneal space in the region of Toldt’s fascia is also accomplished safely again without fear of occult injury to the ureter.