Introduction and hypothesis
The objective was to describe a technique for the robotic repair of complex vesicovaginal fistula (VVF) with uterine preservation.
From 2015 to 2017, two patients underwent the procedure. Following placement of the patient in the lithotomy position, catheterization of the fistulous tract and laparoscopic omental harvesting is performed. Then, the robotic system is docked. A transverse incision was made in the peritoneum above the uterus was made to provide access to the bladder, the uterus is mobilized, and a cystotomy is performed to identify the structures. Subsequently, the cystotomy is extended toward the fistulous tract, the plane between the organs is dissected to proceed with the vaginal closure, the vagina is closed, the omental flap is interposed, and the bladder is closed.
Mean operative time (OT) was 219 min. Mean estimated blood loss (EBL) was 75 ml. One of the patients had an intraoperative cervix canal injury that was identified and repaired. The postoperative course was uneventful, and the mean length of hospital stay (LOS) was 1 day. A mean follow-up of 17 (±9.89) months showed no recurrence at cystoscopy or imaging evaluation.
Uterine-sparing VVF repair is feasible and safe. More studies are needed to assess equivalence compared with other procedures.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Ghoniem GM, Warda HA. The management of genitourinary fistula in the third millennium. Arab J Urol. 2014;12(2):97–105. https://doi.org/10.1016/j.aju.2013.11.006.
Sori DA, Azale AW, Gemeda DH. Characteristics and repair outcome of patients with vesicovaginal fistula managed in Jimma University teaching hospital, Ethiopia. BMC Urol. 2016;16(1):41. https://doi.org/10.1186/s12894-016-0152-8.
Bodner-Adler B, Hanzal E, Pablik E, Koelbl H, Bodner K. Management of vesicovaginal fistulas (VVFs) in women following benign gynaecologic surgery: a systematic review and meta-analysis. PLoS One. 2017;12(2):e0171554. https://doi.org/10.1371/journal.pone.0171554.
Tarney CM. Bladder injury during cesarean delivery. Curr Womens Health Rev. 2013;9(2):70–6. https://doi.org/10.2174/157340480902140102151729.
Bora GS, Singh S, Mavuduru RS, Devana SK, Kumar S, Mete UK, et al. Robot-assisted vesicovaginal fistula repair: a safe and feasible technique. Int Urogynecol J. 2017;28(6):957–62. https://doi.org/10.1007/s00192-016-3194-2.
Tenggardjaja CF, Goldman HB. Advances in minimally invasive repair of vesicovaginal fistulas. Curr Urol Rep. 2013;14(3):253–61. https://doi.org/10.1007/s11934-013-0316-y.
Paparel P, Caillot JL, Perrin P, Ruffion A. Surgical principles of omentoplasty in urology. BJU Int. 2007;99(5):1191–6. https://doi.org/10.1111/j.1464-410X.2007.06869.x.
Conflicts of interest
Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Electronic supplementary material
About this article
Cite this article
Medina, L.G., Hernandez, A., Sevilla, C. et al. Robotic uterine-sparing vesicovaginal fistula repair. Int Urogynecol J 29, 1845–1847 (2018). https://doi.org/10.1007/s00192-018-3720-5