Robotic transvesical vesicovaginal fistula repair: technical point from a tertiary center

Abstract

Background: The aim of this study was to report the institutional experience with robot-assisted trans-vesical vesico-vaginal fistula (VVF) repair focusing on technical points.

Methods: Patients diagnosed with VVF who came to our observation between December 2020 and January 2024 were included in the analysis. Beyond computed tomography scan, all patients underwent pre-operative cystoscopy; a cystography could also be executed. All patients were scheduled for robot-assisted repair with trans-vesical approach.

Results: Five VVFs were developed after previous gynecological surgery, while one occurred after a urological surgical procedure. The median operative time was 137 min [interquartile range (IQR) (99-150)]. Intraoperative blood loss was negligible. The average hospital stay was six days. The urinary catheter was removed within four weeks (median catheterization time, 16.5 days) (IQR 14-27) after cystography was negative for leakages. One patient reported fever within three months from surgery (Clavien II). Pathology reports were negative for malignancies in all cases. No recurrences were reported during the follow-up.

Conclusions: Robotic repair of VVF with a trans-vesical approach represents a safe and effective surgical option.

Keywords: Fistula; VVF; reconstructive surgery; robotic; surgical technique.