Robotic Reconstruction for Recurrent Supratrigonal Vesicovaginal Fistulas

Hemal, Ashok K.; Kolla, Surendra B.; Wadhwa, Pankaj

doi:10.1016/j.juro.2008.05.020

Cited by 85 publications

(44 citation statements)

References 17 publications

(21 reference statements)

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“…Then, they completed the surgery robotically. After this initial work, additional studies performed a similar transabdominal transvesical approach with excellent results (17)(18)(19)(20)(21)(22)(23)(24)(25). Our results are comparable to other studies in terms of efficacy and lack of recurrence.…”

Section: Discussionsupporting

confidence: 76%

“…Our results are comparable to other studies in terms of efficacy and lack of recurrence. The operation time in robot assisted laparoscopic cases ranges from 110 to 330 minutes (18,(20)(21)(22)(23)(24); and the mean time was 117.5 minutes. The mean estimated blood loss in our series was 100 mL, which is within the range of minimal to 150 mL reported in other studies (18,(20)(21)(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

“…Due to the fistulae characteristics, we preferred the transabdominal approach. When using the transvaginal approach, the vagina is first incised and the fistula tract is identified without performing a cystostomy, which is the main difference with previous robotic work (18)(19)(20)(21)(22)(23)(24). This approach is specifically useful in complex cases in patients with a history of prior surgeries whose vesicovaginal space is difficult to dissect.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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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.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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“…11 and robot-assisted repair. 12 Successful closure of some cases of small size VVF with prolonged catheterisation have been reported by some authors. 13 Closure of the VVF after fibrin glue injection into the fistula has also been reported.…”

Section: Discussionmentioning

confidence: 98%

Vesicovaginal Fistula: Our Experience of 47 Cases in a Tertiary Care Hospital of West Bengal

Datta¹,

Chattopadhyay²,

Mandal³

2016

jemds

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Vesicovaginal Fistula (VVF), an abnormal communication between the urinary bladder and vagina, is one of the most distressing and embarrassing health problem for the ladies. The present observational study was planned to inquire into the demographic and aetiologic pattern of vesicovaginal fistula and the long-term success rate of its surgical management following different techniques of repair in a tertiary care centre of West Bengal, India. MATERIAL AND METHODSA total of 47 patients with vesicovaginal fistula presented at our hospital over a span of nine years, were observed during their course of treatment. The patients were evaluated with clinical history, physical examination, routine laboratory investigations, intravenous urogram and cystoscopy. Then the patients had undergone operation by vaginal or abdominal route. Patients were discharged from the hospital with per urethral catheter. On 21 st post-operative day, routine cystogram was done in every patient before catheter removal to exclude the failure of the operation. RESULTOf the observed 47 patients, 66% were tracked back to their obstetric causes and 34% patients could be linked up to gynaecological aetiology like a complication of hysterectomy or after brachytherapy for carcinoma of cervix. In 23.4% of patients, the repair of fistula was done by vaginal route, whereas in 76.6% cases by abdominal approach. Overall success rate of surgical repair was 87.3%, which is comparable to the success rate mentioned in literature. CONCLUSIONIn spite of a decline in the incidence of vesicovaginal fistula in the western world, it is still highly prevalent in the developing countries. Prolonged obstructive labour was found as the most common aetiology of this devastating condition in our region. Timely intervention with meticulous surgical technique is essential for an acceptable success rate in fistula repair surgery. However, improved obstetric care, institutional delivery, high literacy rate, prevention of early marriage-all are of paramount importance for the prevention of occurrence of this socio-medical problem.

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“…Most of the vesicovaginal fistulae can be repaired by transvaginal route which is associated with least morbidity [20,21]. The abdominal approach is indicated selectively and these are the fistulae suitable for laparoscopic repair [10,11,12,13,14,15,16,17,18,19,20,21].…”

Section: Discussionmentioning

confidence: 99%

Transperitoneal Transvesical Laparoscopic Repair of Vesicovaginal Fistulae: Experience of a Tertiary Care Centre in Northern India

Singh¹,

Sinha²,

Mehrotra³

et al. 2013

Current Urology

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Objective: To present our experience of treating supratrigonal vesicovaginal fistulae by laparoscopic technique and their long-term follow-up. Material and Methods: Between January 2008 and June 2012, 28 cases of supratrigonal fistulas were repaired by laparoscopic transperitoneal transvesical technique with interposition flap. The obstetric fistula was present in 18 and gynecologic fistula in 10 patients. Single supratrigonal fistula was present in 26 patients and in 2 patients there were 2 fistulae lying side to side. The vaginal opening was closed as single layer interrupted suture and cystotomy closed as single layer continuous suture by 3-0 polygalactin. The omentum was used as interposition flap in all except 2 cases in whom postero-superior vesical fold of peritoneum was used. The open conversion was required in 2 cases. The urethral catheter was removed in 4 weeks following a micturating cystogram. Result: The mean fistula size was 1.2 cm (range 0.8-2.5 cm). Open conversion was performed in 2 cases of whom one had excess carbon-dioxide retention and cardiac arrhythmia and in another case the needle of 3-0 polygalactin was avulsed and lost in peritoneal cavity which was recovered following laparotomy. All patients were continent following the catheter removal. The median follow-up is 24 months. None developed any complication related to laparoscopic repair till last follow-up. Conclusion: Laparoscopic repair of supratrigonal vesicovaginal fistulae is an effective and safe minimally invasive treatment with excellent result.

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Robotic Reconstruction for Recurrent Supratrigonal Vesicovaginal Fistulas

Abstract: Our experience suggests that robotic repair for recurrent vesicovaginal fistulas is feasible, results in low morbidity and provides outstanding results. It provides an attractive option for vesicovaginal fistula repair by a minimally invasive approach for the surgeon and the patient alike.

Cited by 85 publications

References 17 publications

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

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

Vesicovaginal Fistula: Our Experience of 47 Cases in a Tertiary Care Hospital of West Bengal

Transperitoneal Transvesical Laparoscopic Repair of Vesicovaginal Fistulae: Experience of a Tertiary Care Centre in Northern India

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