From the Guidelines
The ureter is the structure that should be avoided during ligation of the infundibulopelvic ligament to prevent injury and potential complications such as urinary fistula formation, hydronephrosis, or even kidney loss. During this surgical procedure, the ureter typically courses beneath the infundibulopelvic ligament, making it vulnerable to injury.
Key Considerations
- Before ligating the infundibulopelvic ligament, surgeons should positively identify the ureter by direct visualization, often by gently lifting the peritoneum and observing the ureter's characteristic peristalsis 1.
- The infundibulopelvic ligament contains the ovarian vessels (ovarian artery and vein), which supply the ovary, and must be ligated during procedures like oophorectomy or hysterectomy with salpingo-oophorectomy.
- Some surgeons use techniques like retroperitoneal dissection to clearly separate the ureter from the infundibulopelvic ligament before ligation, enhancing safety 1.
- In difficult cases, placement of ureteral stents preoperatively can help with identification and prevention of injury.
Prevention of Ureteral Injury
- The principles for a proper ureteric reconstruction are good vascular supply, adequate drainage, and a wide spatulated tension-free mucosa-to-mucosa anastomosis 1.
- Immediate repair of iatrogenic urinary tract injuries (IUTIs) can be achieved with good results, and the role of the urologist in the operating room is fundamental when an IUTI is suspected 1.
From the Research
Structures to Avoid During Ligation of the Infundibulopelvic Ligament
- The ureter is a critical structure that should be avoided during ligation of the infundibulopelvic ligament 2, 3, 4.
- The uterine artery and vein are also important structures to identify and preserve during this procedure 5, 3.
- The ovarian vessels, which run through the infundibulopelvic ligament, should be carefully dissected and preserved to maintain ovarian function 3, 4.
- The external iliac vessels and the internal iliac artery should be identified and avoided during dissection of the uterine artery 5.
Surgical Techniques to Prevent Injury
- Retroperitoneal dissection and high ligation of the infundibulopelvic ligament can help prevent ovarian remnant syndrome and injury to surrounding structures 4.
- Careful identification and dissection of the ureter and uterine artery can help prevent injury to these structures 5, 2, 3.
- The use of surgical techniques such as blunt dissection and selective coagulation can help minimize the risk of injury to surrounding structures 5, 3.