To illustrate a technique of robotic vesicovaginal fistula repair in a patient with a prior history of pelvic radiation therapy and multiple abdominal surgeries.
Stepwise demonstration of the technique with narrated video footage.
Barretos Cancer Hospital, Brazil.
A 59-year-old woman presenting with vesicovaginal fistula, who had a past history of rectosigmoidectomy followed by pelvic radiotherapy for Stage III colon cancer 23 years before, and robotic hysterectomy, bilateral salpingo-oophorectomy, omentectomy with bilateral pelvic and para-aortic lymphadenectomy for stage II Mixed Cell Endometrial carcinoma, which needed surgical reintervention because of a pelvic hematoma and complete vaginal cuff dehiscence.
Robotic vesicovaginal fistula repair.
We performed a robotic approach to vesicovaginal fistula with several key strategies to perform the fistula repair and maintain the integrity of the abdominopelvic structures: 1-Careful bowel adhesiolysis involving multiple segments of the intestine to the abdominal and pelvic peritoneum. 2-Cystotomy using a vaginal probe guidance. 3-Fistulectomy by monopolar scissors, after ureteral orifices visualization. 4-Dissection of the retropubic space of Retzius, taking off bladder tension. 5-Transverse sutures to coapt the raw surfaces on the vaginal side and the bladder in two layers with minimal tension. 6-Transurethral instillation of methylene blue into the bladder.
Traditionally, patients with vesicovaginal fistula after pelvic radiation therapy and multiple abdominal surgeries are managed by laparotomy. This video demonstrates a feasible robotic approach to vesicovaginal fistula repair, with superior imaging affording a three-dimensional vision and stabilization of instruments allowing wrist-like movements.
Journal of minimally invasive gynecology. 2019 Jul 25 [Epub ahead of print]
Leandro Nóbrega, Carlos Andrade, Ronaldo Schmidt, Ricardo Reis, Marcelo Vieira
Barretos Cancer Hospital- Gynecologic Oncology Department. Electronic address: ., Barretos Cancer Hospital- Gynecologic Oncology Department.