V11-11: Robotic Closure of a Recurrent Vesico-vaginal Fistula after Emergency Cesarean Section, Hysterectomy and Failed Primary Closure of the Fistula.
VideoIntroductions and Objectives
Repair of a recurrent vesico-vaginal fistula mostly is a challenging surgical problem. The video shows the outstanding advantages of robot assisted approach in a difficult case of a recurrent vesico-vaginal fistula.
After failure of the primary attempt to close a vesico-vaginal fistula created during an emergency cesarean section and hysterectomy, robot assisted closure of the fistula was performed by the urologist. 4 robotic trocars and 2 assistant trocars were used similar to the position in radical prostatectomy. The intervention was performed transperitoneally in 45 degrees Trendelenburg position. The fistula was resected free and excised, both ends were closed and a peritoneal flap was interposed.
Docking-time was 17 min., time at the console 130 min., overall operating time 160 min., blood loss almost none. Follow-up after 10 months was uneventful, the fistula remained closed.
Robot assisted surgery for recurrent vesico-vaginal fistula repair is a safe and effective method with the advantage of fast recovery and optimal cosmesis.