V11-09: Transvesical laparoendoscopic single-site surgery (T-LESS) for post prostatectomy vesicorectal fistula repair: first clinical experience.
VideoIntroductions and Objectives
Some minimally invasive techniques have been introduced to decrease morbidity related to standard laparoscopic procedures. One such approach is laparoendoscopic single-site surgery (LESS). We describe our first clinical experience of using this technique for suprapubic transvesical vesicorectal fistula (VRF) repair.
In October 2013, we carried out the T-LESS repair of a 5-mm in diameter vesicorectal fistula on a 72-year old man, who failed the conservative treatment with temporary colostomy and Foley catheter placement. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device (TriPort+) via a 1.5-cm incision made 2 cm above the pubic symphysis. A standard 10-mm optic and straight laparoscopic instruments were used. The fistulous tract was dissected and closed in two layers with running absorbable V-Loc barbed suture. A cystostomy tube was left in place for 22 days and Foley catheter for one week.
The operation lasted 155 minutes. The blood loss was minimal. No complications were observed. The postoperative period was uneventful. During a five-week follow-up the patient reported no involuntary discharge of urine into the rectum. Voiding cystourethrogram revealed no presence of VRF and laboratory examination results were all within normal range.
Although substantial development of the instruments and skills is needed, the T-LESS vesicorectal fistula repair appeared to be feasible and safe. Nevertheless, further experience and observations are necessary.