Robot Assisted Laparoscopic Repair of Vesicovaginal Fistula: A Retrospective Study at a Tertiary Care Centre, Chennai, India

Abstract

Introduction: Vesicovaginal Fistula (VVF) is the most common acquired fistula of the urinary tract in women. Robotic surgery is recently introduced for VVF repair and has benefits over conventional methods. Aim: To describe experience with robot-assisted laparoscopic repair of VVF in patients. Materials and Methods: This was a retrospective observational study conducted from February 2014 to February 2018, at Department of Urology, Apollo Main Hospital, Chennai, Tamil Nadu, India. The study included 24 patients who underwent robot-assisted laparoscopic VVF repair. After cystoscopy ureteric catheter was passed through the fistula and retrieved through vagina. Bilateral ureteric catheters were placed simultaneously with vaginal packing. Da Vinci Si robot was docked with patient in trendelenburg position. After trocar placement transperitoneally the fistula was approached. Through vertical or transverse cystotomy, fistula was identified. With the circumferential incision around the fistula, both the bladder and vagina was separated and the fistulous tract was excised. Bladder was closed vertically and vaginal opening was closed transversely interposing the Omentum. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: The mean age of participants was 40.33 years. Elective hysterectomy done for benign conditions (91.67%) was the major cause of VVF in patients followed by emergency hysterectomy (8.33%). All of the patients underwent adhesiolysis while two patients performed right ureteric re-implantation additionally. The median operative time was 127.50 minutes. The median duration of drain and hospital stay was three days each. Urethral Foley’s catheter removal done at 2-3 weeks based on operating surgeon’s preference and the mean duration of follow-up was 26 months. Conclusion: Robot-assisted laparoscopic VVF repair is convenient and an effective approach in the successful management of VVF in complex fistulas and recurrent cases.

Current evidence of robotic-assisted surgery use in functional reconstructive and neuro-urology

“…There are only three studies that included more than 15 patients, with a respective mean operative time of 127.5 min (100-270), 133 ± 48 min and 187 min (151-219 min), and a reported success rate of 100%, 93.3% and 91%. 57,58,67 Most surgeons have used the conventional transvesical approach with some form of tissue interposition. A robotic extravesical approach for VVF repair was first reported in 2007 by Schimpf et al 63 In summary, due to the small number of VVF cases repaired robotically in addition to the heterogeneity of studies, there is a need for more prospective and comparative studies with greater patient numbers and longer follow-ups.…”

“…While gynaecological surgery, in particular abdominal hysterectomy, is the most common cause of VVF in developed countries, persistent obstructed labour is the most common cause in developing countries. 57 Transvaginal approach is advocated for low-lying VVF, while the transabdominal approach is recommended for supratrigonal or complex VVF, when vaginal access is difficult, or when concomitant intra-abdominal surgery is being considered.…”

“…There are only three studies that included more than 15 patients, with a respective mean operative time of 127.5 min (100–270), 133 ± 48 min and 187 min (151–219 min), and a reported success rate of 100%, 93.3% and 91%. 57 , 58 , 67 …”