Robotic Assisted Vesicovaginal Fistula Repair with The Novel HugoTM RAS System

Fistula repair has been described with existing robotic platforms. We describe trocar placement, docking and surgical steps of vesicovaginal fistula repair using the Hugo™ RAS system. Two patients with vesicovaginal fistulas secondary to hysterectomy were operated on after obtaining informed consent. Transperitoneal laparoscopic vesicovaginal fistula repair was performed using the Hugo™ RAS system which is a new multi-modular robotic platform created by Medtronic, with an open surgical console and individual robotic arms. Four robotic arms were used. Surgical procedure started by placement of ureteral stents and fistula catheterization. Trocars were inserted and 4 independent arms were docked in a “butterfly configuration”. Position of the bedside assistant to the right side of the patient. Surgeon at the open console. Robotic assisted laparoscopic surgical steps: adhesiolysis, incision of the bladder and dissection of the fistula tract, removal of fistula, horizontal closure of vagina and vertical closure of the bladder with absorbable sutures, with interposition of perivesical fat with peritoneum. Patient ages were 42 and 47 years old. Patients BMI were 31 and 25. Docking time: 4 min and 2 min. Operative time: 230 min and 255 min. Console time: 142 min and 171 min. Hospital stay: 2 days. At follow up of 12 months for one patient and 3 months for the other patient, both reported being dry, both patients had normal sexual function without dyspareunia. There were no conversions, no complications. Vesicovaginal fistula repair with the Hugo™ RAS system is safe and feasible, with adequate initial results.