腹腔鏡下子宮全摘術に尿管カテーテル留置は必要か?
～同一術者による99例の検討成績～

抄録

Objective: Laparoscopic hysterectomy (LH) and total laparoscopic hysterectomy (TLH) are associated with a higher incidence of urinary tract injury. We investigated whether ureteral catheter placement immediately before surgery improves intraoperative outcomes and protection of the urinary tract in laparoscopically assisted vaginal hysterectomy (LAVH), LH, and TLH.
Methods: There were 56 patients treated by LAVH, 30 by LH, and 13 who underwent TLH, constituting 99 cases, all performed by the author. Pre-operative placement of ureteral catheters was conducted in 85 cases, including all of the LH and TLH cases and 42 of the 56 LAVH cases. Operative procedures, operating times, uterine weights, blood loss, and intraoperative complications were examined retrospectively.
Results: The time necessary for ureteral catheter placement was about 20 min. Although we converted 2 cases from LAVH to laparotomy, no serious complications, including ureteral injury, developed in any of the surgeries. The ureteral catheter placement caused the ureters to jut like tents, which allowed us to easily confirm their course laparoscopically. With LAVH, the operating time and intraoperative bleeding in the catheter-placement group were significantly worse than in the non-catheter placement group. Blood loss during TLH was significantly reduced compared to LAVH or LH in the presence of the catheters .
Conclusions: The pre-operative placement of ureteral catheters did not improve intraoperative outcomes in LAVH. Although ureteral catheters may contribute to protection of the urinary tract, the present results suggest that ureteral catheter placement is not essential for laparoscopic hysterectomy.