Hysterectomy when done through broad ligament causes injury to?
ANSWER: (B) UreterREF: Shaw's 13th ed p. 14, Danforth 10th ed page 456, COGT 2009 ed chapter 48, The 5-Minute Obstetrics and Gynecology Consult edited by Paula J. Adams Hillard page 582Ureter lies in the pararectal space in the medial leaf of broad ligament in pelvis, hence when dissecting through it during hysterectomy, its liable to get injured."During vaginal hysterectomy, the ureter can be traumatized at its entry point at the trigone""Uterine artery ligation consists of placing a no. 1 absorbable suture 2 to 3 cm medial to the uterine vessels through the myometrium and then through an avascular space in the broad ligament. To avoid injury to the ureter, it is important not to go too far lateral in the avascular space"Urinary injuries during hysterectomy:Urinary injuries during laparoscopy have a similar rate to open procedures (0.02-1.7%). Bladder injuries are more common than ureteral injuries and are recognized more frequently intraoperatively, About two-thirds of urinary injuries occur during laparoscopic-assisted vaginal hysterectomy.The most common sites of ureter injury during gynaecological surgeries:Where the ureters enters the pelvis, near the pelvic brim, during ligation of ovarian vesselsWhere the ureter crosses medial to the bifurcation of the iliac vessels during pelvic lymph node dissection3. Where the ureter crosses under the uterine vessels at the level of the broad ligament during ligation of the uterine vessels during hysterectomy
Bladder
Ureter
Transverse colon
Urethra
Operative Gynaecology