Robotic-assisted vesicovaginal fistula repair using an extravesical approach without interposition grafting

Kelly, Erin; Wu, Maria Y; MacMillan, J. Barry

doi:10.1007/s11701-017-0694-0

Cited by 7 publications

(3 citation statements)

References 11 publications

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“…The major steps of the procedure do not differ from the multiport approach (24)(25)(26). Key elements begin with finding the posterior bladder and vaginal cuff.…”

Section: Vesicovaginal Fistula Repairmentioning

confidence: 99%

Single port robotic assisted reconstructive urologic surgery—with the da Vinci SP surgical system

et al. 2020

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Background: Single port (SP) robotic assisted laparoscopic surgery was approved by the FDA for urologic surgery and clinically available in 2018. This new robotic system enables a camera and 3 separate instruments, with fully wristed motions, to be placed through a single 25 mm port. This system was designed to perform complex surgery in narrow deep spaces making it very suitable for complex urinary tract reconstruction surgery. This paper will describe our early experience of using the SP system for several types of urinary reconstruction procedures and will present our lessons learned, surgical philosophy to using the SP and early data. As with all new technologies, there is an associated learning curve and nuances to be discovered and overcome. Methods:The da Vinici SP™ surgical system was acquired and delivered to at our institution in January 2019. Five high volume robotic urologic surgeons at our institutions underwent certification with the da Vinci SP™ and have been adding this technology into their armamentarium. Almost all cases were recorded for quality improvement initiatives and evaluated with the goal of creating standard operating procedures in terms of access, steps of procedure and minimizing pit falls. Data from all patients undergoing SP urinary tract reconstruction that were entered into our prospective institutional database were reported.Results: From 1/2019 to 8/2019 we have performed 71 urologic SP cases with the SP of which 18 were for urinary tract reconstructive procedures. These cases included 15 pyeloplasties, 1 buccal mucosa ureteroplasty, 1 ureteral implant and 1 repair of vesico-vaginal fistula. This paper outlines our standard operating procedures for table positioning, port placement, access and surgical steps for these complex SP cases. Our early data suggests that use of the SP system for urinary reconstruction is safe and reproducible. Conclusions:The SP robotic surgical system has the potential to be used for nearly all robotic urologic reconstructive procedures. Advantages include a superior cosmetic result and ability to access all surgical quadrants without re-docking or repositioning. Limitations include no near infrared fluorescence imaging, smaller working space and slightly increased difficulty with retraction. We believe these obstacles will be overcome with time and experience. The da Vinci SP™ surgical system, in our initial experience, appears to be as safe and effective as its multiport counterpart for reconstructive surgeries.

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“…The major steps of the procedure do not differ from the multiport approach (24)(25)(26). Key elements begin with finding the posterior bladder and vaginal cuff.…”

Section: Vesicovaginal Fistula Repairmentioning

confidence: 99%

Single port robotic assisted reconstructive urologic surgery—with the da Vinci SP surgical system

et al. 2020

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“…Conservative strategies can be attempted in selected cases, with at best modest success, utilizing bladder drainage, fulguration or targeting the fistulas with injectables or fibrin sealants . The mainstay of treatment remains surgical repair, delivered by a plethora of routes; laparoscopic, robotic or open abdominal and vaginal . The choice of surgical route and timing of VVF repair is multifactorial and determined by patient factors, such as BMI, comorbidities, previous abdominal surgery and availability of interposition flaps, and VVF factors, such as etiology, bladder capacity, position, accessibility from the vagina and associated ureteric injury .…”

Section: Introductionmentioning

confidence: 99%

“…4 The mainstay of treatment remains surgical repair, delivered by a plethora of routes; laparoscopic, robotic or open abdominal and vaginal. [5][6][7] The choice of surgical route and timing of VVF repair is multifactorial and determined by patient factors, such as BMI, comorbidities, previous abdominal surgery and availability of interposition flaps, and VVF factors, such as etiology, bladder capacity, position, accessibility from the vagina and associated ureteric injury. 7,8 It is recognized that rates of success after a second or subsequent attempt at repair are not as good as those after primary repair.…”

Section: Introductionmentioning

confidence: 99%

Incidence, type and management of ureteric injury associated with vesicovaginal fistulas: Report of a series from a specialized center

et al. 2019

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Objectives To report a large series of vesicovaginal fistula, and to assess the incidence of ureteric injury in association with vesicovaginal fistula. Methods We retrospectively reviewed a prospective database of patients with vesicovaginal fistula referred to our center between 2004 and 2016. Data on patient demographics, fistula etiology, mode of repair, and any associated ureteric injury and its treatment were noted. Results Overall, 116 patients (median age 49 years, range 23–88 years) were referred for management of vesicovaginal fistula during the study period. Four of these patients (3.4%) had associated ureteric injury, one of whom had bilateral injury. Ureteric obstruction alone was noted in two patients, ureterovaginal fistula alone in one patient, and bilateral ureteric obstruction and ureterovaginal fistula in one patient. All ureteric injuries were managed with simultaneous reimplantation into the bladder at the time of vesicovaginal fistula repair. Five patients had post‐radiotherapy vesicovaginal fistula, and the remainder were post‐surgical. Three patients with post‐radiotherapy vesicovaginal fistula proceeded to primary diversion. Conclusions Ureteric injury is far less common than previously reported, occurring in <5% of patients presenting with vesicovaginal fistula. It can be successfully managed, and it remains the major indication for abdominal repair of vesicovaginal fistula.

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Fistulae and Sinuses

Jones¹,

Aboumarzouk²

2019

Blandy's Urology

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Robotic-assisted vesicovaginal fistula repair using an extravesical approach without interposition grafting

Abstract: We have demonstrated that a VVF repair, using a robotic-assisted, extravesical approach without interposition graft placement, can be safe, less invasive and have a successful outcome at 1 year of follow-up.

Cited by 7 publications

References 11 publications

Single port robotic assisted reconstructive urologic surgery—with the da Vinci SP surgical system

Single port robotic assisted reconstructive urologic surgery—with the da Vinci SP surgical system

Incidence, type and management of ureteric injury associated with vesicovaginal fistulas: Report of a series from a specialized center

Fistulae and Sinuses

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