VM31 - Delayed Detection and Immediate Repair of Iatrogenic Ureteral Injury in Laparoscopic Anterior Resection with Partial Cystectomy: Lessons Learned

Purpose/Background: A T4 rectosigmoid colon cancer invaded bladder requires oncologic en-bloc resection of the bladder. During the operation, there is a chance of encountering a ureteral injury. The delayed diagnosis leads the patient to wait for the appropriate time of surgical repair, resulting in significant patient inconvenience and clinical challenges. This video intends to illustrate the pitfalls during the laparoscopic anterior resection with partial cystectomy causing ureteral injury and why a delayed detection occurred.

Methods/Interventions: A 72-year-old male with T4 rectosigmoid colon cancer involving the bladder underwent laparoscopic anterior resection with partial cystectomy. Postoperatively, urinary leakage raised concern for bladder leakage, prompting conservative management for 2 weeks. Persistent leakage led to further investigation. A CT scan with cystography revealed an iatrogenic left ureteral injury without bladder leakage. The patient immediately underwent repair in the third postoperative week. This video highlights the operative challenges encountered during our review.

Results/Outcomes: The diagnosis of ureteral injury was initially obscured by the suspicion of bladder leakage following a partial cystectomy. The delayed diagnosis occurred due to the initiation of conservative management. After detecting the injury, the patient immediately underwent left ureteric re-implantation and experienced an uneventful discharge in the second postoperative week. A video review revealed challenging aspects that could provide vulnerable insights for future procedures.

Conclusion/Discussion: During concomitant partial cystectomy, the ureters must be identified clearly. The suspicion of bladder leakage post-cystectomy can obscure the iatrogenic ureteral injury. The delayed diagnosis of the ureteral injury could be promptly repaired in cases where the preceding operation utilized a laparoscopic approach, which is associated with less intraabdominal adhesion.