Attention to the Editor – Case series: “Laparoscopic robot-assisted extravesical repair of vesicovaginal fistula post-hysterectomy: a study of peritoneal flap inlay technique and outcomes”

Vesicovaginal fistulas occur in approximately one out of 1800 hysterectomy cases in Western world countries. Various surgical techniques for fistula repair are described in the literature. This research seeks to introduce our uniform operative technique and assess the results of minimally invasive robot-guided vesicovaginal fistula closure employing a peritoneal flap insert. From 2011 to 2022, surgery was performed on a total of 21 individuals. Nineteen patients developed vesicovaginal fistulas following hysterectomy, while two presented with more complex fistula formations. We evaluated surgical metrics, perioperative adverse events, and functional results, encompassing continence, well-being, emotional effects, and sexual health, measured via validated surveys. Fistula closure was successfully accomplished in all 21 instances. The median operative duration was 216 min (range: 110–459 min), accompanied by negligible blood loss (< 50 ml) and no intraoperative complications. The median hospital stay was 5 days (range: 2–13 days). Postoperative cystography confirmed a watertight bladder suture in all cases. All individuals preserved continence, and throughout a median monitoring period of 20 months, no recurrence of the fistula was observed. Questionnaires assessing life satisfaction, psychological distress, and female sexual function showed significant improvements (p < 0.0001). The laparoscopic, robot-assisted extravesical approach for repairing vesicovaginal fistulas after hysterectomy, incorporating a peritoneal flap inlay, represents a reliable and effective reconstructive technique. This method enhances postoperative recovery, contributes to better quality of life, and supports the restoration of sexual function, making it a valuable option for surgical vesicovaginal fistula repair.