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Robotic vesico-vaginal fistula repair with no omental flap interposition

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Abstract

Introduction and hypothesis

A vesico-vaginal fistula (VVF) is a fistulous tract that connects bladder and vagina, causing urine leakage via the vagina. In the developed world, iatrogenic postoperative VVF is the most common case. Classically, when treating a VVF via the abdominal route, an abdominal flap is mobilized and interposed between the bladder and the vagina.

Methods

In our video, we describe a robotic VVF repair technique with no omental flap interpositioning for a vaginal vault-located fistula.

Results

Duration of surgery was 95 min, estimated blood loss was <50 ml. The postoperative course was uneventful. At the 6-month follow-up, which included clinical and cystographic examinations, the patient had not experienced any recurrence.

Conclusion

In our opinion, a two-layered suturing technique using two semi-continuous sutures for vaginal closure and perpendicular interrupted stitches for bladder closure does not require omental flap mobilization, reducing operating time and possible complications related to accidental peritoneal injuries.

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References

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    Einarsson JI, Hibner M, Advincula AP (2011) Side docking: an alternative docking method for gynecologic robotic surgery. Rev Obstet Gynecol 4:123–125

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    Miklos JR, Moore RD, Chinthakanan O (2015) Laparoscopic and robotic-assisted vesicovaginal fistula repair: a systematic review of the literature. J Minim Invasive Gynecol 22:727–736

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    Miklos JR, Moore RD (2015) Laparoscopic extravesical vesicovaginal fistula repair: our technique and 15-years experience. Int Urogynecol J 26:441–446

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    Dutto L, O’Reilly B (2013) Robotic repair of vesico-vaginal fistula with perisigmoid fat flap interposition: state of the art for a challenging case? Int Urogynecol J 24:2029–2030

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    Ezzat M, Ezzat MM, Tran VQ, Aboseif SR (2009) Repair of giant vesicovaginal fistulas. J Urol 181:1184–1188

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Acknowledgements

None.

Author information

Correspondence to Alberto Martini.

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Conflicts of interest

None.

Consent

Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

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Martini, A., Dattolo, E., Frizzi, J. et al. Robotic vesico-vaginal fistula repair with no omental flap interposition. Int Urogynecol J 27, 1277–1278 (2016) doi:10.1007/s00192-016-2989-5

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Keywords

  • Vesico-vaginal fistula
  • Robotic
  • Minimally invasive repair