Journal of Clinical and Investigative Surgery https://doi.org/10.25083/2559-5555 https://proscholar.org/jcis/ ISSN: 2559-5555 To cite this article: Fatih Sumer, Gökalp Okut, Ramazan Kutlu, Mehmet Ali Yağcı, Cuneyt Kayaalp. Ureteral injury during laparoscopic rectal resection and concurrent laparoscopic repair by ureteroureterostomy. J Clin Invest Surg. 2021;6(2):175-177. doi: 10.25083/2559.5555/6.2.16 Ureteral injury during laparoscopic rectal resection and concurrent laparoscopic repair by uretero-ureterostomy Fatih Sumer¹, Gökalp Okut 1* , Ramazan Kutlu 2 , Mehmet Ali Yağcı 3 , Cuneyt Kayaalp 4 1 INONU UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF GASTROENTEROLOGY SURGERY, MALATYA, TURKEY 2 INONU UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF RADIOLOGY, MALATYA, TURKEY 3 ÖZEL ANKA HOSPITAL, DEPARTMENT OF SURGERY, GAZIANTEP, TURKEY 4 YEDITEPE UNIVERSITY SCHOOL OF MEDICINE, DEPARTMENT OF SURGERY, ISTANBUL, TURKEY ABSTRACT Iatrogenic ureteral injury is an uncommon but severe complication of laparoscopic colorectal surgery. If it is detected intraoperatively, conversion to open surgery is usually inevitable. Here, we described a complete ureteral transection during laparoscopic low anterior resection, which was simultaneously repaired by laparoscopic uretero- ureterostomy. The most important points during the anastomosis of two tiny tubular tissues are dissecting the tubular organs without trauma, obtaining meticulous hemostasis without causing any necrosis, and achieving accurate approximation of tissues with the sutures. To the best of our knowledge, this is the first report that focused on laparoscopic repair of ureteral injury during laparoscopic colorectal surgery. As there are still few data on laparoscopic repair of ureteral lesions, no firm conclusions can be drawn. But, in appropriate cases, if intracorporeal suture expertise is available, laparoscopic repair can be done during colorectal surgery. Category: Case Presentation Received: April 16, 2021 Accepted: June 14, 2021 Published: November 15, 2021 Keywords: rectal cancer, laparoscopic colorectal surgery, ureteral injury, laparoscopic ureteroureterostomy * Corresponding author: Gokalp Okut, Inonu University School of Medicine, Department of Gastroenterology Surgery, Malatya, Turkey, 44280 E-mail: gokalp.okut@gmail.com Introduction Iatrogenic ureteral injury is an uncommon but severe complication of laparoscopic colorectal surgery. These injuries can be detected either during or after surgery. If it is detected intraoperatively, a conversion to open surgery is usually inevitable [1]. Here, we described a complete ureteral transection during laparoscopic low anterior resection by harmonic scalpel, which was simultaneously repaired by laparoscopic ureteroureterostomy. To the best of our knowledge, this was the first report that focused on the laparoscopic repair of a ureteral injury during laparoscopic colorectal surgery. Case Presentation A 48-year-old female was referred to our department after colonoscopy and biopsy that showed a 4-cm ulcerous mass in distance of 12 cm from anal verge with histological diagnosis of adenocarcinoma. Her body mass index was 26 kg/m2 and American Society of Anesthesiologists score was I. Computed tomography showed a thickened wall of the upper rectum without metastatic lesion or local invasion. No neoadjuvant chemoradiotherapy was given and laparoscopic rectal resection was planned. The patient was placed in the Lloyd-Davis position and a urinary bladder catheter was inserted. Total five trocars were placed to the umbilicus and to four quadrants of the abdomen. Using the medial-to-lateral dissection method, the mesocolon was opened with a Ligasure (ForceTriad, Covidien, Boulder, CO, USA) along Toldt’s line. Inferior mesenteric artery was exposed and sealed twice and cut close to root by Ligasure. During the dissection of Toldt’s line towards the inferior mesenteric vein, a hemorrhage occurred in the fascia. The bleeding area was aspirated, irrigated and the bleeding vessels were coagulated with Ligasure. Further dissection was moved to find out the left ureter an it was found over the left iliac artery. However, its proximal part was absent. When the proximal stump was examined, it was found in the previously coagulated area. The left ureter had been mistaken for bleeding blood vessel in the Toldt’s fascia and had been sealed and transected.