New England Section of the American Urological Association

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Immediate Evaluation and Robot-Assisted Repair of a Urinary Injury Following Hysterectomy
Robin Djang, MD; John D. Seigne, MB
Dartmouth Hitchcock Medical Center, Lebanon, NH

Immediate evaluation and robot assisted repair of a urinary injury following a vaginal hysterectomy
Background:
Urinary injuries occur in approximately 0.33% of gynecologic laparoscopic procedures for benign indicationsi. Of these, the majority are recognized intra-operatively and require surgical repair.
Methods:
A 48-year-old women sustained an injury to her trigone during a vaginal hysterectomy. The patient was transferred to our hospital where the injury was evaluated cystoscopically, radiographically and laparoscopically. The injury was repaired acutely in a laparoscopic, robot assisted fashion.
Results:
The accompanying video illustrates the following principles; #1: Appropriate evaluation of a urinary injury following gynecological surgery; #2: Separation and mobilization of the bladder and vaginal walls to allow a tension free closure; #3: Development of a peritoneal and omental flap to augment the repair; #4: The value of the robotic approach for precise visualization and suturing deep in the pelvis.
Conclusion:
The accompanying video illustrates the principles for evaluation and repair of a urinary injury following hysterectomy and the advantages of a laparoscopic, robot assisted approach in an appropriately selected case.
VIDEO ABSTRACT Please reference: NEAUA-92-ROBIN-DJANG
Endnotes
i Wong JMK, Bortoletto P, Tolentino J, Jung MJ, Milad MP. Urinary Tract Injury in Gynecologic Laparoscopy for Benign Indication: A Systematic Review. Obstet Gynecol. 2018;131(1):100-108.


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