Transection of the left ureter
- This can be avoided by dissecting in layers and carefully ensuring that only the mesosigmoid is mobilized laterally.
- Furthermore, the ureter should be identified, but to spare the nerve plexuses running in this region, no extensive exposure should be performed. Also, slinging is not common in our own procedure.
- Insertion of a ureteral stent, closure over it with single button sutures, bladder catheter or suprapubic urinary diversion for 10 days.
Bladder injury
- Suture, bladder catheter or suprapubic urinary diversion for 10 days.
Bleeding from the sacral plexus
- This very serious complication, which can quickly become life-threatening, is avoided by preparing very precisely in the mesorectal fascial plane.
- If bleeding does occur, it is usually not possible to control it by ligation (exception: bleeding after injuries to the internal or external iliac vein). Here it is more sensible to perform tamponade early for several minutes, as long as blood clotting is still stable. Smaller bleedings can be reliably controlled by prolonged compression alone.