Category: Female Urology
Introduction & Objective : The objective of this video is to demonstrate a technique for robot assisted vesicovaginal fistula (VVF) repair utilizing a transvesical approach.
Methods : A 53 year old woman developed a VVF after she underwent an abdominal hysterectomy for uterine fibroids. Additionally, at an outside institution, she had previously undergone 2 attempts at VVF repair; the first being an unsuccessful transvaginal repair, followed by a second repair performed through an open abdominal approach including bladder bivalving and omental interposition. The fistula recurred and she was referred to our institution for further management.
Results : Principles demonstrated in this video include: identification of the fistula tract, fistula mobilization, and tissue mobilization in to 3 different layers - vagina, bladder muscle, and bladder mucosa.
Conclusions : A 3-layer closure is optimal in repair of a vesicovaginal fistula. A robot assisted transvesical approach to vesicovaginal fistula repair is a useful technique especially when previous surgical planes have been used in prior repairs and failed. It maintains a minimally-invasive approach, and may avoid complications associated with an open abdominal approach.
Assistant Professor of Urology and OB/Gyn
Mayo Clinic - Rochester
Dr. Brian Linder, MD, MS is a Senior Associate Consultant at Mayo Clinic with a joint appointment as an Assistant Professor of Urology, and Obstetrics and Gynecology.