LAUSR

Video Objective To demonstrate successful ureterolysis technique when the ureter is abutting the cervix. Setting A 43 year-old multiparous woman with an enlarged fibroid uterus and abnormal uterine bleeding desired definitive surgical management. Her right ureter was abutting the cervix to within less than 0.5cm and required meticulous dissection to maintain its integrity. Interventions Several factors are considered to maintain ureteral integrity during hysterectomy. These include: 1- Identification and dissection of the ureter along the medial leaflet of the broad ligament; 2- In-depth knowledge of the anatomical variations of the parametric; 3- Judicious use of monopolar and bipolar electrosurgery; 4- In-depth understanding of the various effects of electrosurgery on tissues. Conclusion Understanding the course of the ureter is crucial during hysterectomy. When abutting the cervix, judicious use of monopolar and bipolar energy is key to maintain ureteral integrity.