Robotic Repair of Complex Vesicouterine Fistula with and without Hysterectomy

Abstract

Objective: To present robotic repair of vesicouterine fistulae (VUF) with and without hysterectomy in 3 cases and to discuss the technique with its outcome. Methods: Three patients were diagnosed with VUF, of whom 2 had a prior history of multiple cesarean sections and 1 had obstructed labor. Preoperative diagnosis of VUF was based on classic history, cystoscopy and imaging studies. All patients underwent pure robotic repair of VUF with hysterectomy in 1 case. The steps of the technique are cystoscopy, bilateral ureteral catheterization, port placement, adhesiolysis, separation of bladder and uterus and excision of the VUF with freshening of margins, closure of the uterus and bladder, hysterectomy in 1 case, and omental interposition. Results: Robotic repair of VUF was successful in all cases with mean operative time of 127.5 min and average blood loss of 120 ml. One patient underwent simultaneous robotic hysterectomy. All patients were ambulatory on day 1 and were discharged on day 3 with indwelling Foley’s catheter, which was removed on day 10. Conclusion: Robotic repair of VUF is safe and effective with successful outcome in all cases and has all the advantages of open and laparoscopic surgery. If required, concomitant robotic hysterectomy can also be performed. This is the first case series in the world.

Management of Vesicouterine Fistula with Abdominal Approach

“…7 Cerrahi onarımda, açık veya laparoskopik yaklaşımlar denenebilmektedir. 8 Bununla birlikte, bazı küçük fistüller spontan iyileşebilmektedir. Fertilite arzusu bulunmayan hastalarda histerektomi de bir tedavi seçeneği olarak sunulabilmektedir.…”

“…Ancak, postoperatif "de novo urgency" şikâyetleri olan 2 (%50) hastaya postoperatif dönemde antimuskarinik ilaç başlandı. Ortalama 14,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] aylık izlemlerde hiçbir hastada nüks saptanmadı.…”

Robot-assisted urologic surgery in 2010 - Advancements and future outlook

“…[46] Hemal and coworkers presented the first report of robotic repair of complex vesicouterine fistula in three patients and established the procedure to be efficacious with or without concurrent robotic hysterectomy. [47] Feasibility studies have found complex ureterovaginal fistulas to be amenable to robotic ureteroneocystostomy with the robot conferring enhanced identification of relevant anatomical structures. [48] …”

Vesicouterine Fistula Following Vaginal Birth After Cesarean in a Woman With Grand Multiparity: A Case Report and Review of the Literature

“…When compared with previous methods, they UI J [28,29]. Following sharp dissection, the fistulous opening is sutured closed and omentum is interposed between the uterus and bladder for adequate healing, followed by 3 weeks of Foley catheter drainage [28,29].…”