Vesico-Vaginal Fistula Repair: Our Robotic Technique

Abstract

Introduction: Vesico-vaginal fistula presents difficulties in urogynecologic surgeries. The incidence is estimated to range between 0.3% and 2% in 90% of cases after abdominal hysterectomy. Some patients do not improve with conservative measures, and it becomes necessary to perform additional surgery. We want to show that robotic repair technique is a minimal invasive alternative to surgical treatments on this pathology. Materials and Methods (including a description of the video): Based on our experience of laparoscopic vesico-vaginal fistula repair, we have had successfully extrapolated the technique to robotic surgeries. Robotic fistula repair was performed in one patient. In this case, cystoscopy-assisted technique was practiced, with fistulous tract catheterization, resection, bladder and vaginal closure in two layers, as well as flap interposition of epiploic appendix. Results: The patient had had previous hysterectomy and transobturator (TOT) placement for suspected urinary incontinence, the hospitalization was for 1 day, and urethral catheter permanence was for 12 days. The robotic correction performed of the fistula was successful intra and postsurgical outcomes after 4 months follow-up. Conclusions: Robotic repair is a minimal invasive alternative for treatments of vesico-vaginal fistula. Robotic vesico-vaginal fistula repair is feasible and associated with excellent outcomes; this robotic approach provides even greater accuracy in the repair of the vesico-vaginal fistula (VVF). All authors have declared no conflicts of interest exist. Runtime of video: 6 mins 47 secs