Objective: To measure the distance between the ureter and the cervix (UCD) when using a retrograde hysterectomy technique with combination of Anurach uterine manipulator (AUM) and colpotomy to minimize ureteral injury.
Material and Method: Twenty participants, mean age of 39.8 years who underwent total laparoscopic hysterectomy (TLH) during January 2016 and June 2016 at our institution, gave their consents and were enrolled. The combination of AUM and colpotomy in a retrograde technique was used, and the UCD measured before and after applying pressure. Real time fluoroscopy was used to identify and measure the between the lateral cervicovaginal angle and the ureteral catheters in each patient. Kidney-ureter-bladder (KUB) ultrasonograms were evaluated at 48 hours, one week and one month following the surgery in every case.
Results: All procedures were successfully completed without major complications or conversion. The average time of surgery was 113.40 minutes. The range of distances before applying pressure (pre_UCD) on both sides was 1.50 to 1.8 cm with the mean distances of 1.62 cm and 1.63 cm on the left and right sides, respectively. Following this technique, the total distance (post_UCD) was demonstrated in the range of 3.0 to 3.6 cm. The mean increases in the distances (increase_UCD) were 1.50 and 1.58 cm on the left and right sides, respectively. There was no abnormalities of KUB ultrasonograms including the signs and symptoms of urinary complications after operation through one month of follow-up.
Conclusion: With this technique, the surgeons could expect a safer distance of operative area. In the first series of patients, data demonstrated the safety and the benefit of this technique during TLH in decreasing the incidence of ureteral injury. However, evaluation in a larger variety of patients is warranted.

Keywords: Laparoscopic hysterectomy, Ureteral injury, Colpotomy, Ureter to cervix distance