Objective: The aim of the study is to evaluate all cases of ureter injuries and to assess whether identifying course of ureter prevents its injury. Material and Methods: Type of Study: Retrospective analysis Setting: Radhakrishna multispecialty hospital, Bengaluru. The study comprises of 452 cases of difficult TLH done between 2005 to 2016. Inclusion Criteria: uterus size >12wks, endometriosis, large fibroid, adnexal mass, dense adhesions in PID, prior surgeries, ureter anomalies. All cases were analysed in time periods, from 2005 to 2011 (186 cases) and from 2012 to 2016(272 cases) so that we can get the trend of ureteric injuries. The procedure of TLH was kept same for all cases except retroperitoneal dissection of ureter which was done in 272 cases operated between 2012 to 2016. Result: There were total 11 ureter injuries found. Thus the incidence of ureteric injuries came 2.4%. It was found, incidence was 5.9% from 2005 to 2011 while nil from 2012 to 2016.Among the risk factor maximum was endometriosis (60%), 10 cases were diagnosed intraoperatively while 1 diagnosed postoperatively, all 11 cases had lower 1/3rd injury, for 1 case ureteric re-implantation was done while others were repaired using stent.Conclusion: Thus it is concluded that retroperitoneal ureter dissection is a key to prevent ureter injuries in difficult TLH cases where chances of injury are high due to anatomical distortion, hence decreasing the morbidity of patient.

Keywords: Total Laparoscopic Hysterectomy; Ureteric Injury; Ureter Dissection.