Injury to the ureter occurs in 0.1% to 1.5% of pelvic surgeries, but the frequency during laparoscopic surgery is unknown. 1 Evidence suggests that the fre- quency of serious urinary tract complications appears to be on the rise as a result of greater numbers of more increasingly complex operative laparoscopic proce- dures being performed. 2–4 Laparoscopic repair of ureteral injuries offers many possible benefits to the patient, including lower rates of wound infection and incisional hernias. Case Report A 29-year-old woman underwent total abdominal hysterectomy 4 years earlier for endometriosis with chronic pelvic pain. Right and left laparoscopic salpingo-oophorectomies were later performed as two separate procedures for persistent pain. At diagnostic laparoscopy for continued pain she was noted to have bilateral ovarian remnants but no evidence of endo- metriosis. She experienced no symptomatic relief with oral contraceptives, gonadotropin-releasing hormone agonists, nonsteroidal antiinflammatory drugs, or oral narcotics. She was treated in our facility for removal of ovarian remnants. Operative Procedure Laparoscopic excision of the bilateral ovarian remnants was performed after bowel preparation and prophylactic intravenous antibiotic administration. The procedure was performed with four punctures. A 10-mm laparoscope was placed intraumbilically, a 5-mm port was inserted in each lower quadrant, and a third 5-mm port was placed approximately half- way between the right lower quadrant port and the umbilicus. Remnants were densely adherent to pelvic side- walls and required ureterolysis from the pelvic brim to the cardinal ligament. In spite of this, the left ureter was completely transected with laparoscopic scissors 3 cm from the bladder in the process of excising the left ovarian remnant. No energy source was attached to the laparoscopic scissors at the time of the injury. Intravenous indigo carmine dye showed free spill from the proximal ureteral segment. After urologic consultation, both ends of the ureter were spatulated using laparoscopic microscissors. The cut ends were realigned with a single 4-0 polyglycolic acid suture on a ski needle (U.S. Surgical Corp., Norwalk, CT). Thereafter, a 7F, 24-cm, double-J ureteral stent (Microinvasive, Watertown, MA) was placed in 415 August 2000, Vol. 7, No. 3 The Journal of the American Association of Gynecologic Laparoscopists From the Departments of Gynecology and Obstetrics (Drs. Tulikangas and Goldberg) and Urology (Dr. Gill), Cleveland Clinic Foundation, Cleveland, Ohio. Address reprint requests to Jeffery Goldberg, M.D., Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleve- land, OH 44195; fax 216 444 8551. Accepted for publication March 15, 2000. Abstract Injury to the ureter is a possible complication of laparoscopic surgery. Traditionally, it is repaired by laparot- omy. During laparoscopic surgery for bilateral ovarian remnants in a 29-year-old woman, the left ureter was tran- sected. The ureter was repaired by primary end-to-end anastomosis by laparoscopy. The patient recovered uneventfully, and postoperative intravenous puelogram confirmed the repair to be intact. (J Am Assoc Gynecol Laparosc 7(3):415–416, 2000) Laparoscopic Repair of Ureteral Transection Paul K. Tulikangas, M.D., Jeffrey M. Goldberg, M.D., and Inderbir S. Gill, M.D. Reprinted from the JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS, August 2000, Vol.7 No.3 © 2000 The American Association of Gynecologic Laparoscopists. All rights reserved. This work may not be reproduced in any form or by any means without written permission from the AAGL. This includes but is not limited to, the posting of electronic files on the Internet, transferring electronic files to other persons, distributing printed output, and photocopying. To order multiple reprints of an individual article or request authorization to make photocopies, please contact the AAGL.