Table II.
Patient characteristics and ureteral injuries associated with laparoscopic hysterectomy. (BMI- Body mass index, NA-Not available, AUB-Abnormal uterine bleeding, LAVH-Laparoscopic assisted vaginal hysterectomy, LSH- Laparoscopic subtotal hysterectomy, RSO-Right salpingo-oophorectomy, LSO- Left salpingo-oophorectomy, POD- Post operative day, IVP- Intravenous pyelogram, US- Ultrasound, CPP- Chronic pelvic pain, LT-left).
| Case/Year | Age/parity | BMI | Comorbidity | Indications for surgery | Surgery/Energy source used | Presentation | Investigation/Intervention | Legal outcome |
|---|---|---|---|---|---|---|---|---|
| 3/1995 | 26 G1P1 |
NA | Anemia | AUB, Fibroids | LAVH/Stapling device POD #2: Discharged | 6-8 weeks: Low back pain 9 weeks: Lt hydrosalpinx; 3-months: Laparoscopy RSO |
4-months post LAVH: IVP-Lt ureteral obstruction: percutaneous nephrostomy. Reimplantation, resolution. | Dismissed |
| 4/1996 | 40 G3P3 |
39 | Anemia, Hypertension, Asthma | AUB | LAVH/Stapling device. Bleeding right uterine vessel sutured vaginally. Estimated blood loss 900mL. | POD #6-9: Worsening abdominal pain, fever, urine per vagina. POD #6: US-Ileus | POD #9: IVP-Rt distal ureteral transection, extravasation of urine-Nephrostomy. POD #17: Laparotomy, Rt ureter stapled/transected. Reimplantation with psoas hitch | Dismissed |
| 5/1997 | 48 G2P2 |
NA | None | AUB Dys-menorrhea, chronic endometritis. |
LAVH/Stapling device. POD #1: Discharged | POD #8: Back pain. | POD #8: US & IVP-Rt hydronephrosis, Percutaneous nephrostomy. POD #38: Laparotomy, Rt ureter stapled/transected. Reimplantation with psoas hitch | Dismissed |
| 6/1993 | 53 G3P3 |
NA | Anemia | AUB, fibroids | LAVH+BSO/Bipolar electro-surgery. POD #3: Discharged | POD #7: Low back pain, nausea, vomiting, dysuria, hematuria | POD #7: US; Lt ureter obstruction. POD #10: Percutaneous nephrostomy. POD #16: Pyelogram; Rt ureterovaginal fistula- Stents inserted. POD #60: Resolution of injury | Settlement |
| 7/1996 | 47 G3P2 |
NA | Two previous laparotomies | AUB | LAVH+LSO/Bipolar electro-surgery | POD #2-5: Nausea, ileus POD #6: Discharged POD #14: Urine per vagina. BUN-18.3mmol/L. Serum creatine-469 micromol/L. | POD #14: IVP-Bilateral hydronephrosis, reduced kidney function, pelvic extravasation Rt ureter, vaginal extravasation Lt ureter. Laparotomy: Bilateral reimplantation | Trial-Negligence. Likely thermal injury. |
| 8/2012 | 49 | NA | None | AUB | LAVH/Bipolar electro-surgery | POD #10-16: Abdominal pain, intermittent urinary retention. US: 16cm hematoma. | POD #16: laparoscopy-no hematoma. CT scan: Left ureteral transection. Percutaneous nephrostomy. 4 months: laparotomy-Reimplantation | Trial-Negligence. Over-turned on appeal |
| 9/2000 | 41 G5P2 |
24 | None | AUB, Fibroid uterus CPP, Adnexal cyst | LSH/Bipolar electro-surgery POD #2: Discharged | POD #3: Abdominal pain and distention. BUN and creatinine-normal | POD #3: CT scan-Right hydronephrosis, intraperitoneal fluid. Cystoscopy/retrograde pyelogram: Extravasation of urine into abdomen. Double J-stent: resolution of injury. | Settlement |
| 10/2012 | 32 | NA | None | AUB | LAVH/Harmonic Scalpel | POD #2: Abdominal pain, rising serum creatinine. | POD #2: Laparotomy; Rt ureteral transection at cardinal ligament; Reimplantation. | Trial-No negligence |
| 11/2014 | 52 G0P0 |
58 | None | PMB, Endometrial cancer | LAVH/BSO/bipolar electrosurgery; bleeding/Laparotomy | POD #7 Abdominal pain, elevated serum creatinine. | POD #22: CT: free urine in abdomen, Lt ureteral injury, percutaneous nephrostomy. 1 year: Laparotomy- Reimplantation | Settlement |