V251: Laparoendoscopic single-site surgery (LESS) extravesical repair of vesicouterine fistula

Video

Introduction and Objectives
In this video we describe for the first time the technique of laparo-endoscopic single-site surgery (LESS) extravesical repair of vesicouterine fistula (VUF).

Methods
The case that we present in this video is a 32 years old female that presented with Youssef̕ s syndrome following her 3rd cesarean section. Computed tomography (CT) of the abdomen and pelvis revealed a supratrigonal VUF with a localized reaction between the bladder and uterus. Diagnostic cystoscopy revealed a foreign body (gauze) that was protruding into the bladder at the site of the fistula and it was removed cystoscopically. However, the patient̓̕ s symptoms were not resolved. CT cystography and cystoscopy showed persistence of VUF. The fistula was repaired through extravesical LESS using the quadri-port that was inserted at the umbilicus and pre-bent and straight instruments. The fistulas tract was identified and completely excised extravesically using sharp dissection. The edge of the bladder was trimmed at the site of fistulas tract. The uterus was closed by one 3/0 vicryl suture in a figure of 8 fashion, while urinary bladder was closed in 2 layers using 3/0 vicryl suture. An additional 5-mm extraport was added at time of suturing to allow triangulation and hand-free intracoprporeal suturing. An omental flap was interposed between the bladder and uterus. The urinary bladder was drained by an indwelling urethral catheter for 3 weeks.

Results
The operative time was 150 minutes. Blood loss was 90 c.c. There were no intraoperative or postoperative complications. Postoperative hospital stay was 2 days. There was no postoperative urinary leakage. Follow up of the patient (10 months) showed complete clinical cure and no recurrence of vesicouterine fistula.

Conclusions
LESS extravesical repair of vesicouterine fistula is technically feasible and effective procedure that adheres to the principles of transabdominal open surgical repair. However, the procedure is technically challenging and it requires advanced laparoscopic skills.

Funding: none