Vesicovaginal fistula (VVF) is a pathological communication between the posterior bladder wall and anterior vagina. A variety of techniques have been described in the literature but there has only recently been a consensus on best robotic surgical practice. [1] Robotic surgical technique has not been well described with visual demonstrations. We present an original video of a robotic-assisted repair of a VVF with trans-vesical approach and omental interposition.

We outline the key steps in VVF repair, including a cystoscopy to establish the number, size and location of VVF. Bilateral double-J ureteric stents were inserted to protect the ureteric orifices. The VVF was marked by placing a guidewire through the defect via the vagina. A robotic-assisted VVF repair with trans-vesical approach was performed using the da Vinci Xi surgical system. The vesicovaginal space was dissected, the fistula track exposed and fistulectomy performed. Multi-layer, tension-free closure of the vagina and bladder with omental interposition was performed, followed by a leak test to ensure water tight closure. An indwelling catheter (IDC) was inserted at the conclusion of the case.

There were no intra or post-operative complications. The patient was discharged on post-operative day 3 and the IDC was removed on post-operative day 10. At three month follow-up, she did not have ongoing incontinence or recurrence of the fistula.

Robotic repair of VVF is both safe and effective. Robotic surgery facilitates dissection of the vesicovaginal space, mobilization of an omental flap and multi-layer tension-free closure of the bladder and vagina.

Randazzo, M., Lengauer, L., Rochat, C., Ploumidis et al. (2020). Best Practices in Robotic-assisted Repair of Vesicovaginal Fistula: A Consensus Report from the European Association of Urology Robotic Urology Section Scientific Working Group for Reconstructive Urology. European Urology, 78(3), 432-442

Continence 2S2 (2022) 100396
DOI: 10.1016/j.cont.2022.100396