Robotic-Assisted Ureterovaginal Fistula Repair: Report of Efficacy and Feasibility

Abstract

Iatrogenic ureteral injuries are most commonly seen following pelvic and gynecologic surgery. If early conservative endoscopic management fails, surgical correction may be necessary. In this paper, we report 3 cases of the development of ureterovaginal fistula (UVF) after a total abdominal hysterectomy. All 3 cases underwent a robotic-assisted surgical correction. Three female patients (37, 50, and 66 years) were diagnosed with a left-sided ureterovaginal fistula following an abdominal hysterectomy. All patients reported urinary leakage per vagina and were diagnosed on excretory urography. All patients underwent robotic repair of ureterovaginal fistula along with ureteral reimplantation. In all patients, a standard six-port approach was used. Robotic endowrist movement and three-dimensional views aided significantly in the dissection of the viable ureter from periureteral fibrosis and scar. Prior to ureterovesical anastamosis, a double J pigtail stent was inserted intracorporeally through the left 5-mm assistant port. In all cases, the robotic ureteroneocystostomy was completed without complication. Total console surgical time ranged from 62 to 118 minutes. The Foley catheter was removed 24-48 hours after surgery. All patients were discharged completely dry with an indwelling stent in situ. We report a case series of pure robotic ureteroneocystostomy for repair of complex UVF. The da Vinci robotic surgical system provides a tremendous advantage for the gross identification of viable structures within dense scar tissue as well as the identification of healthy ureter for reimplantation. We strongly recommend an early repair of these fistulae with robotic assistance to reduce the period of morbidity.