Robotic management of genitourinary injuries from obstetric and gynaecological operations: a multi‐institutional report of outcomes

Gellhaus, Paul T.; Bhandari, Akshay; Monn, M. Francesca; Gardner, Thomas A.; Kanagarajah, Prashanth; Reilly, Christopher; Llukani, Elton; Lee, Ziho; Eun, Daniel; Rashid, Hani; Joseph, Jean; Ghazi, Ahmed; Wu, Guan; Boris, Ronald S.

doi:10.1111/bju.12785

Cited by 41 publications

(17 citation statements)

References 18 publications

(25 reference statements)

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“…We adopted the bivalve technique with complete excision of the fistula, urether tutoring, and 2 layers suturing, avoiding the omental flap interposition either for its absence or for the impossibility of using it due to post-surgery adhesions involvement. The use of perpendicular orientation layer suturing (horizontal for the vagina and longitudinal for the bladder) as the intrinsic tension generated by the robust suture determined a relative separation of the 2 layers, avoiding the contact between the sutures as also suggested by other authors [7,15] .…”

Section: Discussionmentioning

confidence: 73%

Robot-Assisted Vesico-Vaginal Fistula Repair: Our Technique and Review of the Literature

et al. 2017

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Objective: Our first objective was to report our experience on robot-assisted vesico-vaginal fistula (VVF) repair after radical surgery for gynecologic malignancies without omental flap interposition using a da Vinci robotic system. The second objective was to critically review the literature in order to analyze surgical solutions used to avoid repair failure. Materials and Methods: Five patients with VVF diagnosed after previous open surgery for gynecologic malignancies referred to our tertiary institutions were selected. After an adequate oncologic follow-up, based on the fistula diameter and conservative management failure, robotic surgery repair was proposed. A bivalve 2-layer suturing technique was carried out without tissue interpositions; omentum was not available secondary to previous surgery including hysterectomy, ovaryectomy, and omentectomy and citoreductive peritoneomectomy. A systematic review of the literature was performed in December 2016 using the PubMed database with the following keywords: robotic, robot-assisted, vesico-vaginal, fistula repair. Results: Median age was 62 years (range 55-71) bearing long-lasting VVF were referred to our divisions. Median fistula diameter was 5 mm (range 3-8 mm). Fistula site was the trigone and identified during cystoscopy near the mid-line, left, and right urether meatus, respectively. The median overall and console operatory time were 250 and 120 min, respectively. Blood loss was insignificant (median 40 mL) and the median length of stay was 7 days without any complication. Ten papers were found fulfilling the mentioned criteria, from which 6 were case reports, single or multiple, accounting for the overall 41 robotic-approach-operated patients. Conclusion: The quality of the dissection and suture associated with efficient urine drainage are in our opinion the key elements of the success of our technique, which can be performed even without omentum or other tissue flap or graft interposition.

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Section: Discussionmentioning

confidence: 73%

Robot-Assisted Vesico-Vaginal Fistula Repair: Our Technique and Review of the Literature

et al. 2017

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“…The first report of robotic repair of VVF was by Melamud and colleagues [47] in 2005. Since then the safety and feasibility of the approach have been reported in several case series [48][49][50][51]. Schimpf and colleagues were the first to report the robotic approach without cystotomy (extravesical).…”

Section: Genitourinary Fistulamentioning

confidence: 99%

Robotic Surgery as Applied to Functional and Reconstructive Urology

Osman

Mangır

Mironska

et al. 2019

European Urology Focus

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“…In comparison, this article provides strong evidence for the effectiveness of robot‐assisted (RA) repairs, even for complex injuries. The enviable 95.9% success rate from 47 operations is complemented by short recovery times and low complication rates.…”

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confidence: 98%

“…The multicentre, retrospective study of robotic repair of 49 iatrogenic genitourinary injuries by Gellhaus et al. should therefore serve to reassure gynaecologists with respect to the incidence of this feared complication. This paper, mainly looking at ureteric re‐implants and fistula repairs, constitutes the largest cohort of robotic reconstructions to date.…”

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confidence: 99%

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The robot to the rescue! Editorial on robotic management of genitourinary injuries from obstetric and gynaecological operations: a multi‐institutional report of outcomes

Raison

Challacombe

2015

BJU International

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Robotic management of genitourinary injuries from obstetric and gynaecological operations: a multi‐institutional report of outcomes

Cited by 41 publications

References 18 publications

Robot-Assisted Vesico-Vaginal Fistula Repair: Our Technique and Review of the Literature

Robot-Assisted Vesico-Vaginal Fistula Repair: Our Technique and Review of the Literature

Robotic Surgery as Applied to Functional and Reconstructive Urology

The robot to the rescue! Editorial on robotic management of genitourinary injuries from obstetric and gynaecological operations: a multi‐institutional report of outcomes

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