Robot-assisted extravesical vesicovaginal fistula repair utilizing laparoscopically mobilized omental flap interposition

Kara L. Watts, Richard Ho, Reza Ghavamian, Nitya E. Abraham

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction and hypothesis: High vesicovaginal fistulas (VVF) in the setting of good apical support are best repaired via a transabdominal approach. Laparoscopic VVF repair was first reported in 1998. Several series of robot-assisted VVF repairs have since been published. The robot-assisted approach allows repair of high apical vaginal fistulas while avoiding the morbidity of laparotomy, shortening convalescence, and facilitating the use of omental interposition flaps. This video presents the technique for robot-assisted extravesical VVF repair utilizing a laparoscopically mobilized omental flap. Methods: A 43-year-old woman developed a VVF after a total abdominal hysterectomy for fibroids. Pre-operative CT urogram and office cystoscopy confirmed the diagnosis and ruled out ureteral involvement. She underwent a robot-assisted extravesical VVF repair utilizing a laparoscopically mobilized omental flap. Results: The surgery was uncomplicated, and the patient was discharged on post-operative day 1. A cystogram 2 weeks post-operatively revealed no evidence of a fistula. At 3 months follow-up, the patient denied any urinary incontinence. Conclusions: Robot-assisted extravesical VVF repair avoids the morbidity of a laparotomy, provides excellent exposure, and avoids a large cystotomy. It maintains vaginal length and allows for significantly better visualization compared with the transvaginal approach. This repair offers improved outcomes for certain patients depending on their history, anatomy, and the surgeon’s experience.

Original languageEnglish (US)
Pages (from-to)1-4
Number of pages4
JournalInternational Urogynecology Journal
DOIs
StateAccepted/In press - Dec 6 2016

Fingerprint

Vesicovaginal Fistula
Laparotomy
Vaginal Fistula
Cystotomy
Morbidity
Cystoscopy
Urography
Urinary Incontinence
Leiomyoma
Hysterectomy
Fistula
Anatomy
History

Keywords

  • Omental flap
  • Robotic
  • Vesicovaginal fistula

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Urology

Cite this

@article{0ce4c5bf06d249bfa9d76af9b359cbdf,
title = "Robot-assisted extravesical vesicovaginal fistula repair utilizing laparoscopically mobilized omental flap interposition",
abstract = "Introduction and hypothesis: High vesicovaginal fistulas (VVF) in the setting of good apical support are best repaired via a transabdominal approach. Laparoscopic VVF repair was first reported in 1998. Several series of robot-assisted VVF repairs have since been published. The robot-assisted approach allows repair of high apical vaginal fistulas while avoiding the morbidity of laparotomy, shortening convalescence, and facilitating the use of omental interposition flaps. This video presents the technique for robot-assisted extravesical VVF repair utilizing a laparoscopically mobilized omental flap. Methods: A 43-year-old woman developed a VVF after a total abdominal hysterectomy for fibroids. Pre-operative CT urogram and office cystoscopy confirmed the diagnosis and ruled out ureteral involvement. She underwent a robot-assisted extravesical VVF repair utilizing a laparoscopically mobilized omental flap. Results: The surgery was uncomplicated, and the patient was discharged on post-operative day 1. A cystogram 2 weeks post-operatively revealed no evidence of a fistula. At 3 months follow-up, the patient denied any urinary incontinence. Conclusions: Robot-assisted extravesical VVF repair avoids the morbidity of a laparotomy, provides excellent exposure, and avoids a large cystotomy. It maintains vaginal length and allows for significantly better visualization compared with the transvaginal approach. This repair offers improved outcomes for certain patients depending on their history, anatomy, and the surgeon’s experience.",
keywords = "Omental flap, Robotic, Vesicovaginal fistula",
author = "Watts, {Kara L.} and Richard Ho and Reza Ghavamian and Abraham, {Nitya E.}",
year = "2016",
month = "12",
day = "6",
doi = "10.1007/s00192-016-3218-y",
language = "English (US)",
pages = "1--4",
journal = "International Urogynecology Journal and Pelvic Floor Dysfunction",
issn = "0937-3462",
publisher = "Springer London",

}

TY - JOUR

T1 - Robot-assisted extravesical vesicovaginal fistula repair utilizing laparoscopically mobilized omental flap interposition

AU - Watts, Kara L.

AU - Ho, Richard

AU - Ghavamian, Reza

AU - Abraham, Nitya E.

PY - 2016/12/6

Y1 - 2016/12/6

N2 - Introduction and hypothesis: High vesicovaginal fistulas (VVF) in the setting of good apical support are best repaired via a transabdominal approach. Laparoscopic VVF repair was first reported in 1998. Several series of robot-assisted VVF repairs have since been published. The robot-assisted approach allows repair of high apical vaginal fistulas while avoiding the morbidity of laparotomy, shortening convalescence, and facilitating the use of omental interposition flaps. This video presents the technique for robot-assisted extravesical VVF repair utilizing a laparoscopically mobilized omental flap. Methods: A 43-year-old woman developed a VVF after a total abdominal hysterectomy for fibroids. Pre-operative CT urogram and office cystoscopy confirmed the diagnosis and ruled out ureteral involvement. She underwent a robot-assisted extravesical VVF repair utilizing a laparoscopically mobilized omental flap. Results: The surgery was uncomplicated, and the patient was discharged on post-operative day 1. A cystogram 2 weeks post-operatively revealed no evidence of a fistula. At 3 months follow-up, the patient denied any urinary incontinence. Conclusions: Robot-assisted extravesical VVF repair avoids the morbidity of a laparotomy, provides excellent exposure, and avoids a large cystotomy. It maintains vaginal length and allows for significantly better visualization compared with the transvaginal approach. This repair offers improved outcomes for certain patients depending on their history, anatomy, and the surgeon’s experience.

AB - Introduction and hypothesis: High vesicovaginal fistulas (VVF) in the setting of good apical support are best repaired via a transabdominal approach. Laparoscopic VVF repair was first reported in 1998. Several series of robot-assisted VVF repairs have since been published. The robot-assisted approach allows repair of high apical vaginal fistulas while avoiding the morbidity of laparotomy, shortening convalescence, and facilitating the use of omental interposition flaps. This video presents the technique for robot-assisted extravesical VVF repair utilizing a laparoscopically mobilized omental flap. Methods: A 43-year-old woman developed a VVF after a total abdominal hysterectomy for fibroids. Pre-operative CT urogram and office cystoscopy confirmed the diagnosis and ruled out ureteral involvement. She underwent a robot-assisted extravesical VVF repair utilizing a laparoscopically mobilized omental flap. Results: The surgery was uncomplicated, and the patient was discharged on post-operative day 1. A cystogram 2 weeks post-operatively revealed no evidence of a fistula. At 3 months follow-up, the patient denied any urinary incontinence. Conclusions: Robot-assisted extravesical VVF repair avoids the morbidity of a laparotomy, provides excellent exposure, and avoids a large cystotomy. It maintains vaginal length and allows for significantly better visualization compared with the transvaginal approach. This repair offers improved outcomes for certain patients depending on their history, anatomy, and the surgeon’s experience.

KW - Omental flap

KW - Robotic

KW - Vesicovaginal fistula

UR - http://www.scopus.com/inward/record.url?scp=85001740705&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85001740705&partnerID=8YFLogxK

U2 - 10.1007/s00192-016-3218-y

DO - 10.1007/s00192-016-3218-y

M3 - Article

SP - 1

EP - 4

JO - International Urogynecology Journal and Pelvic Floor Dysfunction

JF - International Urogynecology Journal and Pelvic Floor Dysfunction

SN - 0937-3462

ER -