Same-Day Repair of Recto-Vaginal Fistula Using the Robotic Trans-Anal Minimally Invasive Technique How We Do It

Area of Science:

• Minimally Invasive Surgery
• Surgical Robotics
• Gastroenterology

Background:

• Traditional open rectovaginal fistula (RVF) repair methods have high recurrence and morbidity rates.
• Robotic-assisted surgery offers improved visualization and precision, potentially reducing complications.
• Robotic transanal minimally invasive surgery (R-TAMIS) presents a novel transanal approach for RVF repair.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of the R-TAMIS technique for benign RVF repair.
• To assess the safety and outcomes of robotic-assisted transanal repair for RVF.

Main Methods:

• R-TAMIS using the da Vinci Xi® system for same-day RVF repair.
• Transanal access via GelPOINT Path, robotic port placement, and fistula tract dissection.
• Vaginal and rectal wall closure using barbed sutures, fibrin sealant, and acellular dermal mesh.

Main Results:

• The R-TAMIS procedure was well-tolerated with same-day discharge and minimal pain.
• No major immediate postoperative complications were observed.
• Enhanced visualization and dexterity facilitated precise surgical maneuvers.

Conclusions:

• R-TAMIS is a feasible and effective minimally invasive option for selected benign RVF patients.
• This robotic approach may offer reduced morbidity and improved outcomes over open or laparoscopic methods.
• Proper patient selection and surgical technique are crucial for successful R-TAMIS outcomes.