Robotically Assisted Vesicovaginal Fistula Repair

INTRODUCTION: Vesicovaginal fistulas (VVF) are abnormal connections between the bladder and vagina, often resulting from prolonged obstructed labor, pelvic surgery, or radiation therapy. These fistulas lead to continuous urinary leakage, severely impacting a patient’s quality of life. Robotic-assisted surgical repair has emerged as a minimally invasive and highly effective approach to treating VVFs, offering enhanced precision and faster recovery times compared to traditional open techniques. The following video demonstrates a step-by-step approach to robotically assisted vesicovaginal fistula repair. OBJECTIVE: The purpose of this video is to present the surgical technique of robotically assisted VVF repair, highlighting key steps in the procedure, the advantages of robotic assistance, and important anatomical considerations. The video aims to provide an educational resource for urogynecologists and pelvic surgeons, emphasizing the efficiency, safety, and efficacy of this approach. METHODS: In this 7-minute video, we demonstrate a robotically assisted repair of a vesicovaginal fistula. The patient, a 45-year-old woman, presented with continuous urinary leakage following a prior hysterectomy and a complex medical history. After confirming the diagnosis with cystoscopy, a robotically assisted laparoscopic approach was used. The video details key steps of the procedure, including bladder mobilization, fistula identification, and layered closure of the fistula. The da Vinci Xi robotic system was used to provide enhanced visualization, dexterity, and precision during dissection and suturing. RESULTS: The robotically assisted repair was successfully performed without intraoperative complications. The fistula was closed in a multilayered fashion, ensuring adequate tissue separation between the bladder and vagina. The patient experienced complete resolution of urinary leakage. CONCLUSIONS: Robotic-assisted VVF repair is a highly effective and minimally invasive option for treating complex fistulas. This approach is particularly beneficial for high or complex fistulas. The enhanced precision and superior visualization provided by the robotic platform facilitate meticulous dissection and closure, minimizing complications and improving patient outcomes. This video highlights the technical steps and benefits of robotic surgery in the management of VVF, offering an educational tool for surgeons looking to adopt or refine this technique in their practice.