V1547 TECHNIQUE OF ROBOTIC VESICOVAGINAL FISTULA REPAIR

Abstract

You have accessJournal of UrologyReconstruction1 Apr 2010V1547 TECHNIQUE OF ROBOTIC VESICOVAGINAL FISTULA REPAIR Hany Atalah, Li Ming Su, and Linda Morgan Hany AtalahHany Atalah More articles by this author , Li Ming SuLi Ming Su More articles by this author , and Linda MorganLinda Morgan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1299AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Post-hysterectomy vesicovaginal fistula is a rare event that is associated with significant quality of life consequences. Minimally invasive approaches for vesicovaginal fistula repair have been described. As robotic surgery has expanded to address both upper and lower urinary tract pathology, herein we describe our step-by-step technique of robot assisted vesicovaginal fistula repair. METHODS This instructional video is of a 64 year old female who suffered a vesicovaginal fistula following a prior robotic hysterectomy. Vaginal approach to the fistula was deemed impossible due to the proximal location of the fistula as well as the patient's extremely narrow introitus. The procedure was performed in the dorsal lithotomy position using a 4-armed technique with the da Vinci S system. Ureteral stents were placed intraoperatively to identify the location of the ureters in proximity to the fistula. The vesicovaginal fistula was defined by endoscopic placement of a guidewire through the fistulous tract. The vesicovaginal fistula was excised repaired in multiple layers including interposition of omentum. RESULTS The total operative time was 3.5 hours with minimal blood loss. The patient was discharged on postoperative day #1 and returned for a cystogram study after two weeks of catheter drainage. The patient experienced no complications and has complete continence at this time. CONCLUSIONS Robotic surgery has expanded to address complex reconstructive urologic surgery including vesicovaginal fistula repair. Robot assisted repair may be utilized for proximally located fistulas and is an alternative to open or laparoscopic surgical repair with low morbidity and minimal blood loss Gainesville, FL© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e596 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hany Atalah More articles by this author Li Ming Su More articles by this author Linda Morgan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...