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International Urogynecology Journal

, Volume 29, Issue 12, pp 1845–1847 | Cite as

Robotic uterine-sparing vesicovaginal fistula repair

  • Luis G. MedinaEmail author
  • A. Hernandez
  • C. Sevilla
  • G. E. Cacciamani
  • M. Winter
  • A. Ashrafi
  • I. Gill
  • R. Sotelo
IUJ Video
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Abstract

Introduction and hypothesis

The objective was to describe a technique for the robotic repair of complex vesicovaginal fistula (VVF) with uterine preservation.

Methods

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.

Results

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.

Conclusions

Uterine-sparing VVF repair is feasible and safe. More studies are needed to assess equivalence compared with other procedures.

Keywords

Robotic Vesicovaginal Genitourinary Fistula Uterine 

Notes

Compliance with ethical standards

Conflicts of interest

None.

Consent

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

Supplementary material

ESM 1

(MP4 94084 kb)

References

  1. 1.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Tarney CM. Bladder injury during cesarean delivery. Curr Womens Health Rev. 2013;9(2):70–6.  https://doi.org/10.2174/157340480902140102151729.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    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.CrossRefPubMedGoogle Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    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.CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  • Luis G. Medina
    • 1
    Email author
  • A. Hernandez
    • 1
  • C. Sevilla
    • 1
  • G. E. Cacciamani
    • 1
    • 2
  • M. Winter
    • 1
  • A. Ashrafi
    • 1
  • I. Gill
    • 1
  • R. Sotelo
    • 1
  1. 1.USC Institute of Urology & The Catherine and Joseph Aresty Department of Urology, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Department of Urology, Azienda Ospedaliera Universitaria Integrata (AOUI)University of VeronaVeronaItaly

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