Robotic-assisted laparoscopic repair of a vesicovaginal fistula: a time-consuming novelty or an effective tool?

Pietersma, C.; Schreuder, Henk W.R.; Kooistra, A.; Koops, Steven E. Schraffordt

doi:10.1136/bcr-2014-204119

Cited by 16 publications

(7 citation statements)

References 13 publications

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“…Due to their results, the authors summarized that extravesical VVF repair has similar cure rates compared to the traditional transvesical approach [ 144 ]. Most recent technology used in the treatment of VVF repair is the robotic-assisted approach and some authors reported excellent results with this operation technique [ 23 , 30 , 58 , 98 ]. Disadvantages include increased learning curve, time, costs and surgeons experience.…”

Section: Discussionmentioning

confidence: 99%

Management of vesicovaginal fistulas (VVFs) in women following benign gynaecologic surgery: A systematic review and meta-analysis

et al. 2017

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BackgroundVesicovaginal fistulas (VVF) are the most commonly acquired fistulas of the urinary tract, but we lack a standardized algorithm for their management. Surgery is the most commonly preferred approach to treat women with primary VVF following benign gynaecologic surgery.ObjectiveTo carry out a systematic review and meta-analysis on the effectiveness of operative techniques or conservative treatment for patients with postsurgical VVF. Our secondary objective was to define the surgical time and determine the types of study designs.MethodsPubMed, Old Medline, Embase and Cochrane Central Register of Controlled Trials were used as data sources. This systematic review was modelled on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, including a registration number (CRD42012002097).ResultsWe reviewed 282 full text articles to identify 124 studies for inclusion. In all, 1379/1430 (96.4%) patients were treated surgically. Overall, the transvaginal approach was performed in the majority of patients (39%), followed by a transabdominal/transvesical route (36%), a laparoscopic/robotic approach (15%) and a combined transabdominal-transvaginal approach in 3% of cases. Success rate of conservative treatment was 92.86% (95%CI: 79.54–99.89), 97.98% in surgical cases (95% CI: 96.13–99.29) and 91.63% (95% CI: 87.68–97.03) in patients with prolonged catheter drainage followed by surgery. 79/124 studies (63.7%) provided information for the length of follow-up, but showed a poor reporting standard regarding prognosis. Complications were studied only selectively. Due to the inconsistency of these data it was impossible to analyse them collectively.ConclusionsAlthough the literature is imprecise and inconsistent, existing studies indicate that operation, mainly through a transvaginal approach, is the most commonly preferred treatment strategy in females with postsurgical VVF. Our data showed no clear odds-on favorite regarding disease management as well as surgical approach and current evidence on the surgical management of VVF does not allow any accurate estimation of success and complication rates. Standardisation of the terminology is required so that VVF can be managed with a proper surgical treatment algorithm based on characteristics of the fistula.

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Section: Discussionmentioning

confidence: 99%

Management of vesicovaginal fistulas (VVFs) in women following benign gynaecologic surgery: A systematic review and meta-analysis

et al. 2017

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“…Difficult intracorporeal suturing contributes conversion in two cases of low lying trigonal fistula. Recently introduced DA Vinci robot system for fistula repair provides superior 3D magnified view, better dissection, hemostasis, and suturing with reduced operator fatigue but it is a costly affair at present [24,25].…”

Section: Discussionmentioning

confidence: 99%

Genitourinary Fistula: An Indian Perspective

Priyadarshi

Singh

Bera

et al. 2015

J Obstet Gynecol India

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Background In developing countries, obstetric trauma is the most common cause of genitourinary fistulae. But over the last two decades, health care facilities have been improved and the scenario has been changed. Purpose The aim of the present study is to share our experience with genitourinary fistula in terms of mode of presentation, diagnostic modality, and management with the emphasis on the surgical approach and a parallel review of the available literature. Materials and Method During a 6-year period from January 2007 to December 2013, 41 cases of genitourinary fistula, who admitted and treated in the urology department of a tertiary care center, were retrospectively analyzed for etiology, site, size and number of fistulae, clinical presentation, diagnostic modalities, and management. The literature search was done using the Medline database. Result Mean age of the patient was 27 years (range 16-51). Primary and simple fistulae were common. Obstetric trauma was the most common etiology (56.09 %) followed by iatrogenic (39.03 %). Vesicovaginal fistula was the most common type (78.37 %) and trigone was the most common site involved (51.72 %). 51.35 % of patients were approached successfully by the vaginal route. Ancillary procedures were required in patients for various other associated anomalies at the time of fistula repair. The success rate on follow up was 94.5 %. In the mean follow up of 3 years, 35 patients were sexually active. Conclusion Genitourinary fistula is a frustrating entity with potentially devastating psychosocial consequence. Its management poses a tricky challenge to the surgeon. Accurate and timely diagnosis, adhering on basic surgical principle, and repair by an experienced surgeon provide the optimum chance of cure.

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“…In most cases, laparoscopic management of VVFs takes a relatively long time. The mean operative time in the literature ranges from 70 to 280 minutes in laparoscopic repairs and from 110 to 330 minutes in robot-assisted laparoscopic repairs [16][17][18]. The mean operative time in our study is 41 minutes.…”

Section: Discussionmentioning

confidence: 66%

“…There are some studies comparing bleeding rates in VVF repair in the literature. It was reported that blood loss in robotic surgery was significantly less compared to open surgery (88 vs. 170 mL) [17,19]. In addition, it was reported that blood loss ranges from 50 mL to 125 mL in various laparoscopic repair cases [18].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and initial outcomes of transvesicoscopic bipolar sealing of vesicovaginal fistula

Akkoç¹,

Aydın²

2020

Journal of Surgery and Medicine

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Aim: Vesicovaginal fistula (VVF) is a social and psychological problem for the female population, causing urinary incontinence and foul-smelling urine. Open, laparoscopic, robotic, and various minimally invasive techniques have been described for the treatment of VVF. In this study, we presented the effectiveness and initial outcomes of transvesicoscopic bipolar sealing of vesicovaginal fistula (TBSF), a novel, minimally invasive technique which we had previously described. Methods: This surgical case series included 9 patients with VVF of <1 cm located away from ureteral orifices who underwent TBSF from July 2015 to December 2019. The fistula tract was sealed transvesicoscopically with a bipolar vessel sealer. All patients were informed about the modified surgical procedure prior to the operation. Results: The mean age of the patients was 47.2 (4.6) years. The mean fistula diameter was 6.6 (1.2) mm. The mean operation time was 41 (9.7) minutes. The hospital stay was 1 day in all cases. After catheter removal at 3 weeks, 8 (89%) patients remained dry while one (11%) patient experienced continuous incontinence. Conclusion: Transvesicoscopic bipolar sealing of vesicovaginal fistula is a simple and safe procedure to perform for small VVF, has a short learning curve and operative time, and results in reduced blood loss and morbidity, brief hospital stay and improved cosmesis.

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Robotic-assisted laparoscopic repair of a vesicovaginal fistula: a time-consuming novelty or an effective tool?

Cited by 16 publications

References 13 publications

Management of vesicovaginal fistulas (VVFs) in women following benign gynaecologic surgery: A systematic review and meta-analysis

Management of vesicovaginal fistulas (VVFs) in women following benign gynaecologic surgery: A systematic review and meta-analysis

Genitourinary Fistula: An Indian Perspective

Effectiveness and initial outcomes of transvesicoscopic bipolar sealing of vesicovaginal fistula

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