Ureteral Complications In Deep Endometriosis Surgery Carlo De Cicco by Tamer Seckin
Tamer Seckin: Hi, this is Tamer Seckin from Bari, Italy 17th annual ISG Conference. I have Dr.Carlos Decicco , who has presented this morning a beautiful presentation about complication of endometriosis with respect to ureter. Carlo works with Phillippe Koninckx in Belgium. He is from Italy actually. I want to for the interview sake, this is an internet interview, so it won't be as you don't have as much time; however, highlights of your presentation. I understand there is a significant medicolegal portion of the legal activity against doctors involve in laparoscopic surgery, endometriosis surgery for complication of ureter. Just run by your headlines and let the reviewers around the world learn from your presentation. Please.
Dr.Carlo De Cicco: Thank you. Yeah, this morning I was presenting our experience about ureteral lesion in gynecology. Especially because even if we know that this is around 2, 3% of lesion happen in gynecological surgery. This relates to 6% of medicolegal claims for obstetric and gynecology. So, we know that this is an important issue for all the gynecologists. Well about we were discussing mainly about the deep endometriosis part. So, we had a big series of 1,500 cases of deep endometriosis and we found out that 35 lesions were carried out after deep endometriosis surgery. This is around 2% of incidence. Most important, we found that when a hydronephrosis preoperative was detected then the risk for ureteral lesion intraoperative was 21%. So, this is very impressive, if compared with around 1.5% of lesion. I guess when you don't have any hydronephrosis. This is very important in order to discuss about whenever if you put a stent preoperatively or not because we know that to put a stent is not without any risk. So, to put systematically for every patient that have to do deep endometriosis surgery this can sometimes maybe disadvantage of the patient more than an advantage. Very important, we were discussing about the type of repair you can do to this lesion.
Tamer Seckin: Talking about the repair. How about stents with light, with illumination? Does that make any difference? In my practice I found them helpful to a degree.
Dr.Carlo De Cicco: Yeah these are very, very nice tool. I saw them. But we are not using since at the moment is a little bit complex to have in all the hospitals, so cannot be for everybody at the moment. But I think this is very useful especially for the people that are in the learning core because this help really in preventing injury and to gain experience but probably after several years with surgery, probably this is not really necessary. It would be of help when there will be very, very cheap option.
Tamer Seckin: So, with deep endometriosis, when we talk of deep endometriosis of the posterior pelvis, there is always some degree of ureteral involvement. Mostly, serosal but the injury is high. So, if we found an injury, as a standard, we give methylene blue during the case if we suspect any injury or we are very proximal to it. If we find partial or total transection of the ureter tell us how we should approach the repair?
Dr.Carlo De Cicco: Yeah, we had a very nice experience with laparoscopic suturing. So, we start to think about laparoscopic repair of lesion because this was becoming not only a complication but even an event in case of hydronephrosis. So we have to cure the patient and to find out the solution without requiring every time a urologist to perform a laparotomy or a body flap. So we went to laparoscopic suture and we went through laparoscopic reanastomosis for transection. So, in case of laceration, you can put a couple of stitch just to approximate the ureter after having put a stent, a _____ stent by the urologist and with a laparoscopic assistant. Then this is the same also for the transection. In case you just suspect a coagulation or superficial lesion then you can put a prophylactic stent. We didn't have any case that required laparotomic reimplantation and this was because we always try to go by laparoscopy. Every time this was not possible because we were not in the hospital because we were not maybe in the country. So the urologists were trying to solve their problem. Many of the case they start just with a stent and this if continuous leakage can continue for 4, 5, 6 weeks then it would be very difficult to repair. So, in any case if you have a lesion even postoperative, we go by laparoscopy, put a stent and repair every kind of laceration or transection.
Tamer Seckin: Very good, it's always the patient first, for that purpose I believe in all laparoscopic surgery in every setting urologist who is familiar with the disease endometriosis is a must in the team practice of taking care of endometriosis lesions, and that says it all. I think, ureter is part of the anatomic structures that are frequently attacked by endometriosis. We have to be aware of it. Recognizing it is the first step to prevent complications.
Dr.Carlo De Cicco: Yeah.
Tamer Seckin: Thank you very much.
