Maximizing Success in Urethral Prolapse Surgery

Objective:
The objective of this video is to demonstrate the surgical techniques used for the robotic-assisted repair of a vesicovaginal fistula. Key surgical principles include bladder mobilization, identification and resection of the fistulous borders, tension-free and multi-layer closure, watertight repair, colpotomy closure, and the consideration of omental or peritoneal flap. The video also provides an overview of post-operative care and considerations.

Methods:
This video highlights a robotic repair of vesicovaginal fistula that occurred after robotic assisted total hysterectomy. The fistula repair is shown here with no intra-operative or post-operative complications. CT cystogram performed 2 weeks post-operatively revealed an intact bladder with no evidence of residual or recurrent fistula.

Conclusion:
Vesicovaginal fistula is a rare yet significant complication that may occur after a benign hysterectomy. Robotic assisted repair is a safe, feasible and minimally invasive approach that provides favorable patient outcomes. Knowledge of key surgical principles and post operative considerations is critical in ensuring successful surgical outcomes.