Abstract
Objective
The objective of this video is to demonstrate a technique for robot-assisted vesicovaginal fistula (VVF) repair utilizing a mini cystotomy with a transvesical approach.
Methods
A 53-year-old female developed a VVF after she underwent an abdominal hysterectomy for uterine fibroids at an outside facility. She was referred to us following two failed VVF repairs (one vaginal, one abdominal with bladder bivalving and omental flap). After discussing options, she underwent a robotic VVF repair via a transvesical approach. Following port placement, the space of Retzius was mobilized. An intentional cystotomy was made and the camera and working arms advanced into the bladder. The fistula was identified and circumferentially mobilized. The fistula was closed in three layers using absorbable sutures, and care was taken to avoid the ureters.
Results
The patient’s postoperative recovery was uncomplicated. Follow-up imaging was performed via cystogram at 4 weeks and showed resolution of the fistula.
Conclusions
A robot-assisted transvesical approach using a mini cystotomy to VVF repair is a useful technique especially when previous surgical planes have been used in prior repairs and failed. It maintains a minimally invasive approach and may avoid complications associated with an open abdominal approach.
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References
Bai SW, Huh EH, Jung DJ, Park JH, Rha KH, Kim SK, et al. Urinary tract injuries during pelvic surgery: incidence rates and predisposing factors. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(4):360–4. https://doi.org/10.1007/s00192-005-0015-4.
Blackwell RH, Kirshenbaum EJ, Shah AS, Kuo PC, Gupta GN, Turk TMT. Complications of recognized and unrecognized iatrogenic ureteral injury at time of hysterectomy: a population based analysis. J Urol. 2018;199(6):1540–5. https://doi.org/10.1016/j.juro.2017.12.067.
Teeluckdharry B, Gilmour D, Flowerdew G. Urinary tract injury at benign gynecologic surgery and the role of cystoscopy: a systematic review and meta-analysis. Obstet Gynecol. 2015;126(6):1161–9. https://doi.org/10.1097/AOG.0000000000001096.
Lee RA, Symmonds RE, Williams TJ. Current status of genitourinary fistula. Obstet Gynecol. 1988;72(3 Pt 1):313–9.
Forsgren C, Lundholm C, Johansson AL, Cnattingius S, Altman D. Hysterectomy for benign indications and risk of pelvic organ fistula disease. Obstet Gynecol. 2009;114(3):594–9. https://doi.org/10.1097/AOG.0b013e3181b2a1df.
Hilton P, Cromwell DA. The risk of vesicovaginal and urethrovaginal fistula after hysterectomy performed in the English National Health Service—a retrospective cohort study examining patterns of care between 2000 and 2008. BJOG. 2012;119(12):1447–54. https://doi.org/10.1111/j.1471-0528.2012.03474.x.
Dorairajan LN, Hemal AK. Lower urinary tract fistula: the minimally invasive approach. Curr Opin Urol. 2009;19(6):556–62. https://doi.org/10.1097/MOU.0b013e32833140aa.
Wong MJ, Wong K, Rezvan A, Tate A, Bhatia NN, Yazdany T. Urogenital fistula. Female Pelvic Med Reconstr Surg. 2012;18(2):71–8; quiz 78. https://doi.org/10.1097/SPV.0b013e318249bd20.
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Occhino, J.A., Hokenstad, E.D. & Linder, B.J. Robot-assisted vesicovaginal fistula repair via a transvesical approach. Int Urogynecol J 30, 327–329 (2019). https://doi.org/10.1007/s00192-018-3843-8
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DOI: https://doi.org/10.1007/s00192-018-3843-8