V06-03: Robot-Assisted Laparoscopic Transvaginal Repair of Ileal Conduit Fistula to Vagina
Vesicovaginal fistulae represent the most common fistula of the genitourinary tract. In developing nations, this is most frequently caused by obstructed labor, while in developed countries, these fistulae are most commonly secondary to iatrogenic injuries. There is no consensus for treatment and multiple approaches have been described including transvaginal Latzko procedure, open, laparoscopic, robotic assisted transabdominal approaches, and endoscopic repair. We demonstrate a case of robot-assisted laparoscopic trasvaginal repair of a fistula arising from an ileal conduit to vagina.
The patient is a 68 year old female with a complex urologic history including prior colposuspensions with infected mesh and formation of multiple fistulas including enterovaginal and vesicovaginal fistulas and many surgical repairs. Given her transabdominal surgical history and a long vaginal length of 12 cm, we performed a transvaginal robotic repair of a fistula with a da Vinci Xi (Intuitive) to avoid her hostile abdomen and reach the apex of her vagina. We also utilized Amniofix (MiMedx) as an alternative allograft material for interposition for the fistula repair.
The case, including complex cystoscopy of ileal conduit and loopogram as well as robotic repair of fistula, took 5.5 hrs, total EBL was 10cc. The patient was discharged on post-operative day 1 and has not had a recurrence of this fistula over 7 month follow up.
Transvaginal robot-assisted laparoscopic repair of an enterovaginal fistula from an ileal conduit to the vagina is technically feasible and can provide a reach advantage compared to traditional transvaginal surgery. Interposition can be achieved with an alternative allogfraft material such as Amniofix (MiMedx). This robotic approach can be successful as demonstrated in this moderate-term follow up.