LAPAROSCOPIC CORRECTION IATROGENIC LESIONS
Milton T. Tanaka1, Jose B. Mendes1, Eduado F. Pacagnan1, Sidney Abreu2, Paulo R. Kawano3, Eduardo P. Leonard3, Marcelos Travassos3, Rodrigo Otsuka3, João L. Amaro3, Oscar E. Fugita3
1Master Clínica, Cascavel, Brazil, 2Hospital de Urologia, Brasília, Brazil, 3Hospital das Clínicas, Botucatu, Brazil
Introduction: Laparoscopy has been used to treat a variety of benign and malignant conditions in Urology. However, the laparoscopic cor-rection of iatrogenic lesions poses additional dificulties to the laparo-scopic surgeon such as inflammation and fibrosis due to the previous surgeries as well as the lack of healthy tissue for correction of the lesion in some cases. We present our experience in the laparoscopic correction of 19 iatrogenic lesions.
Method: Nineteen pacients (7 males;12 females) with iatrogenic lesions secondary to pen or endoscopic surgeries were submitted to laparo-scopic correction of the lesions. One patient had 2 consecutive sur-geries. These included 6 vesico-vaginal fistulas, 1 entero-cutaneous fis-tula, 1 uretero-vaginal fistula. 1 foreign body in the ureter , 4 ureteral stenosis following open surgery and 2 following ureteroscopy, 2 for-eign bodies in the collecting system after surgery, 1 intestinal perforation following TVT, and 1 post-pyeloplasty ureteral stenosis.
Result: All 19 pacients completed surgery successfully through a laparoscopic approach including ureterolysis, ureteral reimplantation, vesico-vaginal fistula correction, colon suture, and pylolythotomy.
One patient had intestinal adhesions laparoscopicapilly treated following a ureteral reimplantation. No patient presented any major postoperative complication. The mean hospital stay was 2.8 days and the mean OR time was 3.2 hours.
Conclusion: Laparoscopic approach for correction of iatrogenic lesions is feasible and safe. Larger series and longer follow-up is necessary to determine its precise role.