This case involves a 29-year-old female who underwent a hysterectomy using a robotic surgical technique. According to the medical records, the patient’s ureter was cauterized during the procedure and was obstructed as a result. Several repair surgeries have been attempted with little to no success. The patient is unable to perform up to her previous functional capacity due to the placement of a nephrostomy drainage tube. There is not much optimism for a full recovery.
I regularly perform hysterectomies, primarily vaginal, abdominal, or laparoscopic and sometimes it is with the assistance of the DaVinci robot. Although ureteral injury is a known complication of surgery, it should not occur absent malignancy, severe endometriosis, infection or negligence. That is, we will occasionally, and deliberately, resect a portion of ureter involved with cancer or endometriosis, and at the same surgery reanastomose the cut edges, usually with placement of a ureteral stent. There is no excuse for terminating surgery with an undiagnosed ureteral injury. That is, when operating close to the ureter, we need to assess its integrity before closing the abdominal incisions.
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