Introduction: This video reviews a unique patient case and the surgical management of a vesicovaginal fistula repair using the single port robot through a transvesical approach. A 37-year-old nulliparous female was referred to our department for management of a vesicovaginal fistula after failing conservative management with indwelling Foley catheter for four weeks. The fistula was diagnosed following treatment for locally advanced ovarian adenocarcinoma. Eight weeks prior to presentation, she underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, partial omentectomy, sigmoid resection, and coloanal anastomosis. Her post-operative course was complicated by an anastomotic bowel leak managed conservatively with pelvic drain. The vesicovaginal fistula was diagnosed by x-ray cystogram completed after she reported new urinary incontinence. Methods: Surgical management required creativity due to factors unique to our patient's situation. We recognized transvaginal exposure would be limited due to the patient’s nulliparous status and due to religious and personal beliefs, our patient did not consent to a transvaginal repair. A transabdominal approach would be challenging with her history of multiple complex abdominal surgeries and pelvic abscess. Additionally, ability for tissue interposition would be limited due to a prior partial omentectomy. Results: Using the techniques described in our video, the vesicovaginal fistula was repaired successfully. Our patient was discharged home the same day as surgery. At 15 days post-op, a cystogram was obtained and a successful trial of void was completed. At subsequent follow-up, our patient is doing well with absence of incontinence. Conclusions: Our technique and approach to vesicovaginal fistula repair should be considered in unique situations such as this case. SOURCE OF Funding: None
