Vesico-vaginal fistulas (VVFs) are a public health issue. They are mostly due to sequelae of pelvic surgery in westerns countries. To date, there is no consensus on the repair technique for these VVFs.

We present the case of a 42-year-old woman with a vesico-vaginal fistula that appeared following a subtotal hysterectomy in a context of symptomatic endometriosis. The fistula measured approximately 2cm, was located at the bottom of the bladder and at the level of the distal 2/3 of the vagina.
Because of an insufficiently mobilizable omentum, an interposition of a V-shaped peritoneal flap was performed.
The objective of this video was to present a technique for repairing VVF using a robot-assisted transvesical approach with the interposition of a V-shaped peritoneal flap (V-flap).

The operating time was 170 minutes. The procedure begins with a transverse opening of the bladder dome until the fistula, which is located away from the ureteral meatus. After releasing the edges and dissecting the vesicovaginal space, the fistulous orifice is resected. The vagina is sutured horizontally with a V-lock running suture.
A V-shaped peritoneal flap pedicled on the right umbilical artery was interposed between the bladder and vaginal sutures. The bladder is then sutured vertically with 2 half running sutures of V-lock.
A bladder catheter is placed at the end of the procedure. There were no complications. The patient was able to leave the hospital the day after the surgery. The patient showed no recurrence of the fistula after one year of follow-up.

Repair of vesico-vaginal fistula by robot-assisted transvesical approach is a feasible technique that seems well suited for supra-trigonal fistulas. In the absence of usable omentum, the use of a V-shaped peritoneal flap seems to be an interesting alternative.