Robotic Repair of Rectovesical Fistula Secondary to Open Radical Prostatectomy

Abstract

Introduction: Rectovesical fistula (RVF) is a rare entity that can develop after trauma, radiation, congenital diseases, inflammatory bowel disease, and open radical prostatectomy. Herein we present our experience with robot-assisted fistula repair. Methods: Three patients were treated. The etiology of RVF developed was open radical prostatectomy in all patients. The robotic procedure was postoperative following failed open repair in two patients, and primary in the third. All patients had previously undergone fecal diversion. The operative steps were as follows: (1) cystoscopy, (2) RVF catheterization, (3) five-port transperitoneal laparoscopic mobilization of omental pedicle flap, (4) cystotomy extending toward the fistula tract, (5) robot docking, (6) dissection of the rectovesical plane, (7) interrupted rectal closure, (8) omental interposition, (9) bladder closure, (10) suprapubic tube placement, and (11) drain placement. Results: Mean operative time was 153 mins (range 120–180). No intraoperative or postoperative complications occurred. All patients remain free of fistula recurrence by cystographic studies with follow-up ranging from 2 weeks to 10 months. Bowel continuity has been restored in two patients and is planned in one. Conclusion: While we await longer follow-up and experience in larger series, robotic repair of RVF appears feasible and represents an attractive alternative to open or laparoscopic approaches. No competing financial interests exist. Runtime of video: 7 mins 55 secs