Robotic repair of vesicovaginal fistulae with the transperitoneal-transvaginal approach: A case series

Abstract

ARTICLE INFO ______________________________________________________________ ______________________Objective: To describe a novel technique of repairing the VVF using the transperitoneal-transvaginal approach. Materials and Methods:From June 2011 to October 2013, four patients with symptoms of urine leakage in the vagina underwent robotic repair of VVF with the transperitoneal-transvaginal approach. Cystoscopy revealed the fistula opening on the bladder. A ureteral stent was placed through the fistulous tract. After trocar placement, the omental flap was prepared and mobilized robotically. The vagina was identified and incised. The fistulous tract was excised. Cystorrhaphy was performed in two layers in an interrupted fashion. The vaginal opening was closed with running stitches. The omentum was interposed and anchored between the bladder and vagina. Finally, the ureteral catheters were removed in case they have been placed, and an 18 Fr urethral catheter was removed on the 14th postoperative day. Results: The mean age was 46 years (range: 41 to 52 years). The mean fistula diameter was 1.5 cm (range 0.3 to 2 cm). The mean operative time was 117.5 min (range: 100 to 150 min). The estimated blood loss was 100 mL (range: 50 to 150 mL). The mean hospital stay was 1.75 days (range: 1 to 3 days). The mean Foley catheter duration was 15.75 days (range: 10 to 25 days). There was no evidence of recurrence in any of the cases. Conclusions:The robot-assisted laparoscopic transperitoneal transvaginal approach for VVF is a feasible procedure when the fistula tract is identified by first intentionally opening the vagina, thereby minimizing the bladder incision and with low morbidity.

RETRACTED ARTICLE: Laparoscopic repair of vesicovaginal fistulae with a transperitoneal approach at Universitas Gadjah Mada Urological Institute: a case report

“…Vesicovaginal fistulae (VVF) represent a significant morbidity in female urology with an incidence that varies between 0.3 and 2%, most of which are iatrogenic [1]. It is estimated that 0.8 per 1000 of all hysterectomies are complicated by the development of a VVF.…”

“…The success of VVF repair depends on various factors, including fistulae size, location, timing from the antecedent event, severity, quality of surrounding tissue, clinical experience, and surgical skill [1]. Surgical repairs of VVF are most commonly performed: (1) vaginally, (2) abdominally, and (3) laparoscopically.…”

Management of vesicovaginal fistulas (VVFs) in women following benign gynaecologic surgery: A systematic review and meta-analysis

“…Due to their results, the authors summarized that extravesical VVF repair has similar cure rates compared to the traditional transvesical approach [ 144 ]. Most recent technology used in the treatment of VVF repair is the robotic-assisted approach and some authors reported excellent results with this operation technique [ 23 , 30 , 58 , 98 ]. Disadvantages include increased learning curve, time, costs and surgeons experience.…”

Transvesicoscopic Bipolar Sealing of Vesicovaginal Fistula

“…The mean operative time in the literature ranges from 110 to 330 minutes even in cases of robot-assisted laparoscopic repair cases. 4 The operative time in our case was 65 min. Intraoperative difficulties were noted in the first case, which included grasping the fistula, pressure of insufflation to maintain the pneumovesicum during port insertion.…”