Protect the ureters

From July 1, 2006 to June 30, 2007, 151 patients with complex pelvic pathology underwent placement of lighted ureteral stents by a general surgeon or gynecologist. None of the patients who underwent preprocedure ureteral stent placement had a ureteral injury. The procedures included laparoscopic colorectal surgery (45 pts), hysterectomy/GYN (49 pts), or pelvic adhesions (57 pts). The average time from placement of the stents to start of the operation was 5 minutes (range, 2 to 15). In 6 patients, the stents could not be placed, and all had ureteral pathology that was NOT noted preoperatively. Two patients had ureter injuries at our hospital and did not have ureteral stents placed during the same time period. The cost of the stents is $205. OR time past the first half hour ranges from $560 to $716 for each additional half hour. The time saved from the lighted identification of the ureters versus visual nonstent identification is from zero minutes to 45 minutes. This is an extremely useful procedure that can theoretically reduce ureter injury to zero. In an era in which insurance will not pay for complications related to the original operation and high litigation costs, this procedure should be the standard of care for safely performing complex pelvic surgery.