Robotic repair of rectovesical fistula resulting from open radical prostatectomy

Rectovesical fistula (RVF) is a rare complication of radical prostatectomy. A 57-year-old man underwent open radical prostatectomy with recognized rectal injury, primary closure of the rectal wall, and loop colostomy. The patient developed urine leakage per rectum after colostomy closure. We diverted the fecal stream with end colostomy and placed a suprapubic tube. An open transsacral (Kraske) repair failed 1 month later. We have previously described the laparoscopic approach, and report the technique and results of our first robotic assisted operation.

The operative steps were as follows: (1) cystoscopy, (2) RVF catheterization (3) five-port transperitoneal laparoscopic initial dissection (4) mobilization of omental pedicle flap, (4) cystotomy extending toward the fistulous tract, (5) robot docking (6) dissection of the rectovesical plane, (7) interrupted rectal closure, (8) omental interposition, (9) bladder closure, and (10) drain placement.

Operative time was 180 minutes. Hospital stay was 1 day. The suprapubic tube was removed at 2 months after normal cystography. Bowel continuity was restored at 4 months, with no fistula recurrence at 1-month follow-up.

We await longer follow-up and experience in larger series. For now, robotic repair of rectovesical fistula appears feasible and represents an attractive alternative to open and laparoscopic approaches.