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Robotic repair of a branching vesicouterine and vesicovaginal fistula
Darlene Vargas-Maldonado1, Maraika O Robinson1, Brian J Linder2,3
1Division of Urogynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Introduction And Hypothesis:
We present technical considerations and tips for repairing a complex branching vesicouterine and vesicovaginal fistula via a robotic approach.
Methods:
A 31-year-old female presented with constant urinary leakage following a vaginal birth after prior cesarean section. Evaluation with cystoscopy and cross-sectional imaging demonstrated a branching vesicouterine and vesicovaginal fistula. Repair with robotic-assisted approach was carried out. An intentional cystotomy was made with a tear-drop incision around the fistula tracts. The vesicouterine and vesicovaginal planes were dissected and mobilized. The vaginotomy and cystotomy were closed in a running two-layer fashion with absorbable suture and the uterine defect closed with interrupted absorbable suture. Retrograde bladder filling confirmed a watertight repair. A broad peritoneal flap was created, positioned, and secured with care to ensure it covered past the apex of the fistula closure.
Results:
Following overnight observation she had an uneventful recovery, including catheter removal at 3 weeks after cystogram confirmed resolution of the fistula. At 6 weeks the fistula and her leakage remained resolved, with no de novo voiding or incontinence symptoms.
Conclusions:
A robotic approach to complex branching vesicouterine and vesicovaginal fistula is technically feasible. Careful attention to surgical technique and the use of tissue interposition may improve fistula resolution rates.
