V12-08: Robot-Assisted Vesico-Vaginal Fistula repair: Technique & experience
Standard open trans-abdominal repair of VVF requires a long cystotomy, supra-pubic drainage and delayed recovery while laparoscopic repair in limited by difficult suturing in pelvis with steep learning curve. Utility of robotic assistance is being increasingly explored in difficult pelvic surgeries including repair of vesico-vaginal fistula (VVF). In this current video we share our experience and the technical tips of robot-assisted laparoscopic transvesical VVF repair.
Data of all patients who underwent robot-assisted VVF repair on DaVinci Si system from December 2014 to September 2018 were collected. All cases underwent pre-operative cysto-vaginoscopy and upper tract imaging. VVF repairs were done in Trendelenburg position with 3-arm pelvic docking. Patient characteristics, operative data, post-operative events and follow up outcomes were analyzed
Sixty-four cases of VVF were repaired. Post-hysterectomy VVF was the commonest etiology. 31 patients had complex VVF. Ureteric catheterization was needed in 13 cases due to close proximity to the fistula site. In 2 patients’ simultaneous ureteric re-implantation and in 2 other patients Boari Flap was created (Table 1). Mean durations of drain and hospital stay were 3.4 +/- 1.8 and 9.1 +/- 3.8 days respectively. Follow-up of all patients is available and 2 patients had recurrence. In both the patients the fistula was small and at the previous operative site. Both the fistulae were repaired successfully with robotic assistance. Few useful technical tips for successful outcomes are a. Use of different color catheters across the fistula and ureter. b. Intermittent tugging of the catheter (across the fistula) to identify the site for posterior cystotomy c. Sharp dissection of vaginal and bladder flaps with no or minimal cautrey Interposition of local flaps whenever possible.
Current data suggest that robotic-assisted VVF repair is safe and feasible with good success rate conferring the advantages of minimal invasive surgery