V11-03: ROBOTIC ENTEROVESICAL FISTULA REPAIR
VideoIntroductions and Objectives
After getting the FDA approval for the da Vinci surgical system in intraabdominal surgery, its use in this field gradually increased. Many procedures previously done by open surgery are now performed by robotic surgery. Compared to open surgery, the advantage and superiority of robotic surgery, especially in narrow areas such as the pelvis, has been shown in many studies. This educational video show a step by step approach for robotic enterovesical fistula repair.
The video clip show a robotic enterovesical fistula repair performed in Male of 48 yo, c/o bilateral flank pain and recent event of pyelonephritis treated with antibiotics. This patient has history of UTI, diverticulosis and diverticulitis episodes in the past. He had pneumaturia, dysuria, not fecaluria. Images studies showed colonic diverticulosis. Focal wall thickening and tethering of the bladder dome to the adjacent sigmoid colon, with a droplet of air in the bladder wall and small air fliud level in the bladder lumen. No contrast extravasation from the colon into the bladder noted. Vesical Fistula was seen during cystoscopy in the bladder dome.
The procedure was completed robotically. BMI: 26.6 kg/m2.Surgery time: 108 min. Console time: 76 min. Estimated blood loss: 100 cc. Not peri or postoperative complications. Bowel activity resumption POD 2. Discharge: 3 days PO. Cystogram PO: Negative for leak. Foley was removed. Pathology: Intestinal mucosal fissure with transmural acute and chronic inflammation, abscess formation and foreign body giant cells, intestinal muscularis propia and bladder muscular wall.
Robotic enterovesical fistula repair is a safe and feasible procedure. Although there are many existing studies about minimally invasive surgery, more randomized studies with larger case numbers should be carried out in order to establish the favorable functional outcomes of robotic surgery in addition to its obviously observed advantages.