Minimally Invasive UV Fistula Repair with the Aid of Laparoscopic Ureteroneocystostomy

Abstract

Video Objective We will present two cases which suffered from ureteral vaginal fistula after hysterectomy and underwent repair at our institute. Setting Urban general hospital Japan. Interventions Case 1 complained of fluid leakage two days after laparoscopic hysterectomy. CT showed leakage of urine from the lower ureter. Case 2 was referred to us from another institute after suffering from vaginal fluid leakage for four years. This case underwent abdominal hysterectomy four years ago and two weeks later the patient complained of fluid leakage. Six months later, an urologist made an attempt to repair the fistula but was unsuccessful due to the amount of adhesion the patient was suffering. For Case 1, we performed a laparoscopic uteroneocystostomy with a psoas hitch, which facilitated a tension-free anastomosis for this patient. The most important point of this surgery is meticulous dissection without impairing blood perfusion. This was extremely difficult in Case 2 due to extensive and severe adhesion. Laparoscopic skills for this reconstruction such as laparoscopic suturing and knowledge of fundamentals like tension and torsion free anastomosis are vital for the success of the surgery. No patients experienced stenosis or leaks and no other complications occurred and no blood transfusions were required. The fistulas were repaired without sequel. The patients were able to ambulate and take a normal diet the day after the surgery and could be discharged 4 days after surgery. Conclusion Although knowledge of reconstruction and laparoscopic skills such as intracorporeal suturing and ligation are difficult to master, this technique is valuable in its feasibility and patient friendliness.