V875: Repair of Vesico-Uterine fistula by Single Incision Laparoscopic Surgery

Video

Introduction and Objectives
Since the first laparoscopic surgery in urology in 1990s, it has been used for treatment of a variety of urologic disorders. The benefits are well recognized & known to everyone. A number of papers & case series have been published on Single Incision Laparoscopic Surgery (SILS) extirpative surgery, especially nephrectomy. Applicaltion of SILS for management of complications of previous surgery is limited to occasional case reports. We present a case of 38 yr female with Vesicouterine fistula following complicated Caesarian Section. Fistula was associated with bilateral vesicoureteric reflux with Rt nonfunctioning kidney, managed by SILS repair of fistula with subtotal hysterectomy & Rt nephro-ureterectomy.

Methods
With patients in lithotomy, Lt side was stented as fistula was close to Lt ureteric orifice. After a 2cm periumblical incision was taken, a Size 7 surgical glove was inserted. Three 5mm ports were introduced through the fingers of the glove. The procedure was carried out using laparoscopic working instruments, scope & camera. After identifying the fistula tract, subtotal hysterectomy and closure of cervix was done. This was followed by repair of fistula and omental transposition. Then pt was taken in 70o lateral position for Rt nephro-ureterectomy. We required a rescue port during fistula repair, which was later used for keeping drain.

Results
The duration of surgery was 320 min. The blood loss was 100ml. No blood transfusion was required. The drain was removed on POD3. She was in hospital for 5 days. Foleys was removed after 6 wks and stent removed after 3 months.

Conclusions
Single Incision Laparoscopic Surgery (SILS) is an emerging sub-specialty of Lap-urology gaining acceptance & popularity very quickly. Till date, publications have shown acceptable results of SILS in urology, which are comparable to standard laparoscopic surgery. SILS techniques are still in the early stages of development and additional studies with larger cohorts are required to more accurately determine its role in the field of urologic surgery. Further technological advances with regards to instrumentation and retraction should facilitate implementation of this surgical platform, especially in management of complicated cases like genito-urinary fistulas.

Funding: none