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Review
. 2024 Jul;11(3):357-365.
doi: 10.1016/j.ajur.2023.11.002. Epub 2024 Mar 2.

Robotic management of urinary fistula

Luis G Medina  1 , Randall A Lee  1   2 , Valeria Celis  1 , Veronica Rodriguez  1 , Jaime Poncel  1 , Aref S Sayegh  1 , Rene Sotelo  1
Affiliations
Review

Robotic management of urinary fistula

Luis G Medina et al. Asian J Urol. 2024 Jul.

Abstract

Objectives: To highlight critical preoperative and intraoperative considerations in approaching fistula repair robotically.

Methods: A search of the literature was conducted to identify relevant articles pertaining to robotic management of urinary fistulae.

Results: Fistulae of the genitourinary tract can be a challenging dilemma for urologists, as definitive management may require surgical intervention. Pathogenesis of both enteric and non-enteric fistulae are multifactorial, and successful repair hinges on the meticulous perioperative evaluation, planning, and execution. Traditional open techniques can subject patients to increased morbidity and prolonged hospitalizations. Since its introduction, the robotic surgical platform has continued to expand its indications. Its three-dimensional visualization and tremor free wristed instrument movements have made the robotic platform an attractive option for genitourinary fistula reconstruction.

Conclusion: Robotic management of complex urinary fistulae is feasible in expert hands; more studies are needed to define its role in the treatment algorithm of this devastating conditions.

Keywords: Fistula; Rectourethral; Rectovesical; Robotic surgery; Vesicovaginal.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Cystoscopic view of a vesicovaginal fistula tract.
Figure 2
Figure 2
Port placement configuration.
Figure 3
Figure 3
Illustration showing the robotic system docked with the patient in Trendelenburg's position and another surgeon performing a cystoscopy for cases in which cannulation of the ureters or the fistulous tract is needed.
Figure 4
Figure 4
Cannulation of the fistulous tract and both ureters in preparation for a robotic surgical repair to aid with the intraoperative identification of these structures.
Figure 5
Figure 5
Retrovesical and transvesical approaches for vesicovaginal fistula repairs. (A) Retrovesical approach (between bladder and vagina); (B) Transvesical approach (cystotomy).
Figure 6
Figure 6
Transperineal urethral mobilization. (A) Perineal midline incision; (B) Urethral dissection and exposure; (C) Retrograde advancement of the urethra; (D) Vesicourethral anastomosis.
See this image and copyright information in PMC

References

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