Category: Robotic Surgery: Lower Tract - Benign

VS6-11 - Robotic approach in a complex patient with vesico-vaginal fistula

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective : Present a robotic approach in a very complex patient with a vesico-vaginal fistula 


Methods : We present a 68 y old female with smoking habits, and the background of Diabetes Mellitus 2 and Arterial Hypertension. 
With a history of a Vaginal hysterectomy 1 year ago from an endometrial cancer with extension to rectus and colon, during the procedure the patient presented a colon perforation that require an exploratory laparotomy and a colostomy in 2016, the patient received coadyuvant radiotherapy 
During the discharge presented with total vaginal urinary incontinence with the use of 2 diapers per day, when she arrived at our institution we found a vesico-vaginal fistula of 2mm diameter in the vaginal sack with urine leakage
Initally we performed a open approach that failed 4 days later with recurrence of the fistula
We performed a robotic fistulectomy, performing initially a canulanization of the fistula with a urethral cathether, once in cavity we encounter many adhesion that have to be removed because of the anatomy of the patient, once the adhesion were creating a good cavity performed a vertical incision in the bladder to expose the urethral cathether and make a resection of the fistula between the bladder and vaginal wall.
The vaginal wall was closed with vycril 3-0, and the bladder wall with stratafix 2-0, at the end of the closure performed a filling of the bladder with the encounter of no urinary leaks from the vaginal wall o the bladder wall. 
The patient was discharged from the second postoperative day with no urinary incontinence at the moment. 


Results : The robotic approach in a complex patient with vesicovaginal fistula should be always considered if the anatomy or background of the patient needs it.


Conclusions : The repair with the da Vinci Robot is an excellent tool to the surgeon to do and excellent conclusion in complicated patients. 

Roberto PATRICIO. Lopez Maguey

resident
Hospital Dr. Manuel GEA Gonzalez
Mexico, Distrito Federal, Mexico

Pascual ARMANDO. Cortes Raygoza

Urology Resident
Hospital General Dr Manuel Gea Gonzalez
Tlalpan, Distrito Federal, Mexico

Ivan Calvo Vazquez

Hospital General Dr. Manuel Gea González
Mexico City, Distrito Federal, Mexico

Mario Enrique Ortega Gonzalez

Hospital General Dr. Manuel Gea González
Mexico City, Distrito Federal, Mexico

Erick Alejandro Hernandez Mendez

Hospital General Dr. Manuel Gea González
Mexico City, Distrito Federal, Mexico

Jorge Gustavo Morales Montor

Hospital General Dr. Manuel Gea González
Mexico City, Distrito Federal, Mexico

Carlos Martinez Arroyo

Academic staff
Hospital General Dr. Manuel Gea González
Mexico City, Distrito Federal, Mexico

Mauricio Cantellano Orozco

Hospital General Dr. Manuel Gea González
Mexico City, Distrito Federal, Mexico

Gerardo Fernandez Noyola

Hospital General Dr. Manuel Gea González
Mexico City, Distrito Federal, Mexico

Carlos Pacheco Gahbler

Urology Chief Division
Hospital General Dr. Manuel Gea González
Mexico City, Distrito Federal, Mexico