Vineet Agrawal1, Victor Kucherov1, Emma Bendana2, Jean Joseph1, Hani Rashid1, Guan Wu3. 1. Department of Urology, University of Rochester Medical Center, Rochester, NY. 2. Department of Urology, Good Shepherd Medical Center, Longview, TX. 3. Department of Urology, University of Rochester Medical Center, Rochester, NY. Electronic address: guan_wu@urmc.rochester.edu.
Abstract
OBJECTIVE: To describe our surgical technique and outcomes with robot-assisted laparoscopic repair of vesicovaginal fistula (VVF) in 10 patients. METHODS: From November 2010 to April 2014, a total of 10 patients with VVF underwent robot-assisted laparoscopic VVF repair. The principles of VVF repair were followed. The fistula tract was excised. The vagina defect and the cystotomy were closed with a flap of epiploica of sigmoid colon, a peritoneal inlay, or a bladder adventitia layer interposed between the bladder and vaginal suture lines. Perioperative patient characteristics, complications, operative data, and follow-up results were retrospectively reviewed with institutional review board approval. RESULTS: All 10 patients developed VVF as a result of previous elective hysterectomies for benign indications. Mean operative time was 214 minutes (range, 120-457 minutes). Longer operative times were caused by concomitant surgeries (3 ureteral reimplantations and 1 planned sigmoid colectomy). Median length of stay was 1 day (range, 1-5 days). There were no intraoperative complications. Perioperatively, there was 1 Clavien-Dindo grade 1 complication (ileus), and 2 grade 2 complications (readmission with Clostridium difficile infection and atelectasis). All patients were cured and were without VVF recurrence at a median follow-up close to 2 years. CONCLUSION: Robot-assisted laparoscopic VVF repair is an effective approach to manage VVF even in complex medical scenarios. It is anticipated that an increasing number of VVF repairs will be undertaken with robot-assisted approach in the future, offering more patients who need VVF repair the advantages of minimally invasive surgery.
OBJECTIVE: To describe our surgical technique and outcomes with robot-assisted laparoscopic repair of vesicovaginal fistula (VVF) in 10 patients. METHODS: From November 2010 to April 2014, a total of 10 patients with VVF underwent robot-assisted laparoscopic VVF repair. The principles of VVF repair were followed. The fistula tract was excised. The vagina defect and the cystotomy were closed with a flap of epiploica of sigmoid colon, a peritoneal inlay, or a bladder adventitia layer interposed between the bladder and vaginal suture lines. Perioperative patient characteristics, complications, operative data, and follow-up results were retrospectively reviewed with institutional review board approval. RESULTS: All 10 patients developed VVF as a result of previous elective hysterectomies for benign indications. Mean operative time was 214 minutes (range, 120-457 minutes). Longer operative times were caused by concomitant surgeries (3 ureteral reimplantations and 1 planned sigmoid colectomy). Median length of stay was 1 day (range, 1-5 days). There were no intraoperative complications. Perioperatively, there was 1 Clavien-Dindo grade 1 complication (ileus), and 2 grade 2 complications (readmission with Clostridium difficileinfection and atelectasis). All patients were cured and were without VVF recurrence at a median follow-up close to 2 years. CONCLUSION: Robot-assisted laparoscopic VVF repair is an effective approach to manage VVF even in complex medical scenarios. It is anticipated that an increasing number of VVF repairs will be undertaken with robot-assisted approach in the future, offering more patients who need VVF repair the advantages of minimally invasive surgery.
Authors: Girdhar S Bora; Shivanshu Singh; Ravimohan S Mavuduru; Sudheer K Devana; Santosh Kumar; Uttam K Mete; Shrawan K Singh; Arup K Mandal Journal: Int Urogynecol J Date: 2016-11-14 Impact factor: 2.894
Authors: Mubashir Shabil Billah; Michael Stifelman; Ravi Munver; Johnson Tsui; Gregory Lovallo; Mutahar Ahmed Journal: Transl Androl Urol Date: 2020-04