V2159: Suprapubic transvesical laparoendoscopic single-site surgery (LESS) for vesicovaginal fistula repair: initial clinical experience.
VideoIntroduction 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 initial clinical experience of using this technique for transvesical vesicovaginal fistula (VVF) repair.
In August 2011, we carried out the LESS repair of a 5-mm in diameter vesicovaginal fistula on a 72-year old woman, who failed the conservative treatment with Foley placement. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device (4-channel) 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 partially excised. The bladder and vaginal walls’ defects were closed in two layers with running absorbable V-Loc™ suture. Ureteral catheters were left for 5 days and Foley catheter for 14 days
The operation lasted 170 minutes. The blood loss was minimal. No complications were observed. The postoperative period was uneventful. During a two-month follow-up the patient reported no involuntary discharge of urine into the vagina. Diagnostic scans revealed no presence of VVF and laboratory examination results were all within normal range.
Although substantial development of the instruments and skills is needed, the transvesical LESS vesicvaginal fistula repair appeared to be feasible and safe. Nevertheless, further experience and observations are necessary.