Identification of the ureter and dissection of the bladder pillar in laparoscopic-assisted radical vaginal hysterectomy

BACKGROUND: Identification of the ureter and transection of the bladder pillar are the hallmarks of radical vaginal hysterectomy. TECHNIQUE: First, the supraureteral part of the bladder pillar is transected laparoscopically. After identification of the ureter by the "click" maneuver, the infraureteral part of the bladder pillar is transected vaginally. Then, the rest of the supraureteral part of the bladder pillar is exposed by eversion of the uterine fundus and transected vaginally. EXPERIENCE: Between August 1994 and May 1997, 71 women were treated consecutively for cervical cancer stages IA2-IVB. Our new technique was performed in 16 women and compared with 55 patients in whom traditional techniques were used. Intraoperative and postoperative data were recorded prospectively. The duration of the vaginal phase of the operation was shortened significantly with our new technique compared with traditional techniques. There was no significant difference in intraoperative and postoperative injuries to the bladder or to the ureter for the various techniques. CONCLUSION: Our technique of identification of the ureter and dissection of the bladder pillar may prove a valid alternative to the traditional techniques, with statistically significant time gain.