Further Dissection and Transection of the Ureters

The ureters are identified as they cross the iliac vessels and dissected down to the bladder. The ureters are clipped distally (Fig. 5). During this dissection care is taken to leave ample tissue around the ureter and thus preserve its vascular supply. Laparoscopically, it is possible to dissect the ureters closer to the bladder than during open surgery. However, one must be sure to get negative surgical margins. Therefore, once the ureters are divided, the distal ureteral margins are sent for frozen section pathologic analysis with the right and left ureter marked separately. The clips are left on the ureter to allow dilation for later anastomosis. A long stay suture is passed through the distal ureter to facilitate later identification and traction. It is prudent to complete the cephalad ureteral dissection at this point. The limit of ureteral dissection is typically 4-5 cm where it crosses the iliac artery.

FIGURE 6 ■ Posterior pedicle dissection FIGURE 5 ■ Transection of right ureter demonstrating showing Endo-GIA on right posterior pedicle with clips on either side with stay suture through proximal end. care taken not to transect the distal ureteral stump.

FIGURE 6 ■ Posterior pedicle dissection FIGURE 5 ■ Transection of right ureter demonstrating showing Endo-GIA on right posterior pedicle with clips on either side with stay suture through proximal end. care taken not to transect the distal ureteral stump.

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