Category: Robotic Surgery: Lower Tract - Benign

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. 

Presenting Author(s)

• RL

  Roberto Lopez Maguey

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

Author(s)

• PC

  Pascual Cortes Raygoza

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

  Ivan Calvo Vazquez

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

  Mario Enrique Ortega Gonzalez

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

  Erick Alejandro Hernandez Mendez

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

  Jorge Gustavo Morales Montor

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

  Carlos Martinez Arroyo

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

  Mauricio Cantellano Orozco

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

  Gerardo Fernandez Noyola

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

  Carlos Pacheco Gahbler

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