Extraperitoneal transvesical repair of a supratrigonal vesicovaginal fistula using transurethral illumination and laparoscopic instruments: A minimally invasive approach beyond transvaginal or transabdominal repair

This is a 56-year-old woman with a history of endometrial cancer who underwent multiple abdominal gynecological surgeries and pelvic radiation therapy. She subsequently developed a 2-cm supratrigonal vesicovaginal fistula following transurethral resection of a solitary bladder recurrence of her endometrial cancer. Given her oncologic history and the altered abdominal anatomy resulting from prior surgeries and radiation, we performed an extraperitoneal transvesical repair using transurethral illumination and laparoscopic instruments. A shorter and lightweight telescope, such as an ear, nose, and throat sinuscope, was utilized to improve surgical ergonomics. This minimally invasive approach allowed us to avoid entering the peritoneal cavity, thereby reducing the risk of organ injury associated with transabdominal repair in such complex cases. To illustrate this technique, we present this case report with step-by-step procedural guidance.