Background: Reported techniques of vesicovaginal fistula repair include transvaginal, transabdominal, and endoscopic approaches. Depending on the size and location of the fistula as well as degree of vaginal descent, there are advantages and disadvantages to each approach. To date, there is one case report of robotic-assisted laparoscopic repair of a vesicovaginal fistula. We present our technique and experience with our first case.
Methods: A 41 year old woman underwent an emergent total hysterectomy and bilateral oophorectomy for bleeding. Several weeks later, she presented with vaginal discharge. A Pyridium tampon test and computerized tomography scan demonstrated a vesicovaginal fistula. On cystoscopy, a 1 cm opening was noted 2 cm posterior to the inter-ureteric ridge. There was little vaginal descent, and the fistula was difficult to see on vaginal examination. 3 months after the original surgery, the patient underwent a robotic-assisted laparoscopic repair of a vesicovaginal fistula. The patient was placed in dorsal lithotomy, bilateral ureteral stents were placed, and an open ended ureteral catheter was passed through the fistula and out the bladder for through and through access. Utilizing a robotic-assisted transabdominal approach, the fistula was identified, sharply mobilized, excised, and repair in multiple layers with a piece of sigmoid epiploic fat placed between the layers.
Results: The patient was discharged on postoperative day one. Cystogram 3 weeks postoperatively did not demonstrate extravasation. The Foley catheter was removed, and the patient continues to do well 4 months postoperatively.
Conclusions: Robotic-assisted laparoscopic repair of a vesicovaginal fistula is a feasible, straightforward alternative to open transabdominal repair with all the potential benefits of a minimally invasive approach.