As gynecologic endoscopic surgery advanced in the late 1980s and early 1990s, the linear cutter stapling device became a widespread method of securing the uterine vascular pedicles. Unfortunately, ureteric injuries were reported when this device was used in conjunction with laparoscopic hysterectomy (LH). Bipolar coagulation subsequently became the preferred method, but there was concern that thermal energy might damage the ureter. The authors reviewed their first 1275 laparoscopic hysterectomies to determine the risk of ureteric injury. The procedure was offered to patients seen in 2 private gynecologic practices in Australia over the past decade. It used a linear cutter stapling device to secure the uterine vascular pedicles.
Stapling caused 4 ureteral injuries in the first 275 cases, an incidence of 1.45%. Two of these injuries occurred at the pelvic brim when securing the ovarian vessels and 2 occurred deep in the pelvis when securing the uterine vessels. Only one ureteric injury occurred with use of the stapler in the next 1000 cases (0.1%) in a patient having 2 previous midline cesarean section deliveries, multiple uterine fibroids, and congenital abnormal ureters that formed a bilateral duplex collecting system. The upper ureter was injured in the course of removing a difficult fibroid. One nonstapler-related ureteric injury was caused by inserting a sharp-tipped trocar. All injured ureters were successfully reimplanted into the bladder either concurrently or at later surgery. The stapling device caused no other significant injuries.
In experienced hands, the risk of injuring the ureter when using staples to secure the uterine vessels during LH is no greater than when bipolar diathermy is used for this purpose.