Abstract

Vesico-vaginal fistulas are rare in the western world and are usually a complication of gynecologic surgery. We describe in this video our technique of robotic repair of complex vesico-vaginal fistulas by interposition of a pedicled peritoneal flap.

Salient features of the technique are as follow: cystoscopy with bilateral ureteral stenting; placement of a 5 Charr catheter into the fistula brought out through the vagina; posterior longitudinal cystotomy; excision of the fistula; viable tissue between vagina and bladder is found; opening of the vesico-vaginal septum and mobilization of the vaginal flaps to allow transverse tension-free closure; double-layer longitudinal bladder closure to avoid overlapping sutures; interposition of a pedicled peritoneal flap between the two perpendicular suture lines.

Three patients underwent robotic repair of vesico-vaginal fistula by the use of a pedicled peritoneal flap. Mean operative time was 127 minutes. No intraoperative or postoperative complications were encountered. Hospital stay was between two and three days. Catheter was removed at 2 weeks postoperatively. At 10 months we did not observe any fistula recurrence.

Robotic repair of complex vesico-vaginal fistula using a pedicled peritoneal flap can be safely and efficiently performed. It represents a minimally invasive alternative to the standard open repair.