V380 ROBOTIC-ASSISTED LAPAROSCOPIC REPAIR OF A VESICORECTAL FISTULA FOLLOWING RADICAL PROSTATECTOMY AFTER INITIAL FAILED OPEN REPAIR

Abstract

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence), Oncology & Prostate Cancer1 Apr 2011V380 ROBOTIC-ASSISTED LAPAROSCOPIC REPAIR OF A VESICORECTAL FISTULA FOLLOWING RADICAL PROSTATECTOMY AFTER INITIAL FAILED OPEN REPAIR Guan Wu, Christine Mastrodenato, Jonah Marshall, and Hani Rashid Guan WuGuan Wu Rochester, NY More articles by this author , Christine MastrodenatoChristine Mastrodenato Rochester, NY More articles by this author , Jonah MarshallJonah Marshall Rochester, NY More articles by this author , and Hani RashidHani Rashid Rochester, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.467AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Repair of a vesicorectal fistula is a challenging surgery. This surgery becomes even more difficult after an initial repair is unsuccessful. In this video, we demonstrate a successful robotic-assisted repair of a vesicorectal fistula. METHODS The patient is a 72-year-old obese gentleman who developed a vesicorectal fistula following a rectal injury during radical prostatectomy. He subsequently underwent sigmoid colostomy, then open transabdominal repair of his fistula with omental flap interposition. Unfortunately, the repair failed. The patient was referred to our medical center. We elected to perform his repair utilizing a robotic approach. The patient was placed supine on a split-leg operating table with a 15-degree Trendelenburg position. Both ureters were catheterized with 5F ureteral catheters through cystoscopy. A Foley catheter and a rectal tube were placed. A total of 4 ports were placed, including a 12-mm accessory port in the right upper quadrant close to the anterior axillary line, a 12-mm camera port and two 8-mm robotic arm ports. The left robotic arm port was placed below the colostomy to avoid injury. Extensive lysis of adhesions was required. The bladder was bivalved through the dome down to the trigone. The vesicorectal fistula area was debrided. The rectum defect was closed in two layers with 3-0 Monocryl sutures, an omental flap interpositioned, and the bladder was closed in two layers with 3-0 Monocryl sutures. RESULTS The entire repair procedure was done robotically. Operative time was approximately 4 hours. Estimated blood loss was 50 ml. Postoperative course was uneventful and the length of hospital stay was 6 days. A cystogram done 4 weeks after surgery showed no leak and his Foley catheter was removed. At the 4-month followup, his cystogram and sigmoidoscopy showed no signs of vesicorectal fistula recurrence and he is scheduled for colostomy reversal. CONCLUSIONS A robotic-assisted laparoscopic repair of vesicorectal fistula is a feasible alternative to open surgery in selected patients, even in the setting of a colostomy and failed initial open attempts at repair. The robotic surgical system provides us a platform to perform complex laparoscopic repair of the urinary tract in the deep pelvic area. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e154 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Guan Wu Rochester, NY More articles by this author Christine Mastrodenato Rochester, NY More articles by this author Jonah Marshall Rochester, NY More articles by this author Hani Rashid Rochester, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...