2013 Annual Meeting-Robotic Assisted Laparoscopic Vesicovaginal Fistula Repair with Omental Interposition

Video Transcription

This is a video of Robotic Assisted Laparoscopic Vesicovaginal Fistula Repair with Omental Interposition.  At the beginning of the surgery, cystoscopies performed and bilateral temporary ureral stents are placed.  Port placement is similar to the Robotic Assisted Laparoscopic Sacroglopopexy. Sharp dissections are used to dissect the plane between the bladder and the vagina.  As seen in this video, this plane can be scarred secondary to previous attempts at fistula repair or continuous inflammation from urine exposure.  The fistula is encountered and further dissection is carried out to freely mobilize the bladder opening from the vaginal opening.  Careful dissection is needed to free up the bladder from the anterior vagina.  Visceral suture is used to close the bladder opening. The vaginal opening is closed perpendicular to the cystotomy incision to prevent overlapping suture lines.  A second layer is used for vaginal closure. Note that the tissues are being approximated freely without any tension and after closure there is plenty of space between them.  At this point, a distal tongue of omentum is interposed between the bladder and the vagina. Many times the omentum is scarred to the abdominal wall.  Mobilization of the omentum to reach the fistula site may be limited by robotic arm trajectory and this deep trendylumbar positioning.  In order to completely mobilize the omentum, laparoscopic dissection may be needed prior to docking the robot.  Three interrupted sutures are used to secure the omentum in the most distal part of the  We have used the robotic assisted laparoscopic approach for three patients with two of them having more than 11 months follow up.  The etiology of vesicovaginal fistula in all of these patients was total abdominal hysterectomy.  Currently all three patients are dry with closed fistulas and no need for further intervention.  Robotics technology provides excellent exposure in the pelvis, aiding in meticulous dissection and attention free fistula repair.  The abdominal approach provides ready access to the omentum for interposition.

Video Summary

This video demonstrates a robotic assisted laparoscopic vesicovaginal fistula repair with omental interposition. The surgery begins with cystoscopies and placement of temporary ureral stents. Sharp dissections are used to separate the bladder from the vagina, which can be scarred due to previous repair attempts or inflammation. The fistula is located and further dissection is performed to free up the bladder opening. The bladder opening is closed using visceral sutures, and the vaginal opening is closed perpendicular to prevent overlapping suture lines. The omentum is then interposed between the bladder and vagina. Robotic technology allows for precise dissection and successful fistula repair. The procedure was performed on three patients, who all have no further issues or need for intervention. The video does not provide any credits.

Meta Tag

Category surgical video

Category fistula-vesicovaginal

Category surgery

Category Minimally Invasive Procedures

Category fistula

Category PFD Week 2013

Session 182183

Keywords

robotic assisted laparoscopic vesicovaginal fistula repair

omental interposition

cystoscopies

ureral stents

bladder-vagina separation