Document Detail


Robotic reconstruction for recurrent supratrigonal vesicovaginal fistulas.
MedLine Citation:
PMID:  18639266     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: We report our experience with robotic reconstruction for recurrent supratrigonal vesicovaginal fistulas and its outcome. MATERIALS AND METHODS: From August 2006 to October 2007 we treated 7 cases of recurrent supratrigonal vesicovaginal fistula. Salient features of our technique are 1) vaginoscopy and cystoscopy with bilateral Double-J stent or ureteral catheter placement and placement of a catheter through the fistula from vagina to bladder, 2) patient positioning in a low lithotomy position with a 60-degree Trendelenburg tilt and a 5-port transperitoneal approach, 3) peritoneoscopy and adhesiolysis with minimal posterior cystotomy encircling the fistulous opening, 4) mobilization of the bladder and vaginal flaps to allow tension-free closure, 5) excision of the fistulous rim, 6) bladder and vaginal edge freshening, 7) bladder and vaginal closure, 8) omental, peritoneal or sigmoid epiploic tissue interposition and 9) insertion of a Foley catheter and drain. Difficulty was primarily noted with regard to the safe establishment of pneumoperitoneum, the need for extensive adhesiolysis, dissection of the fistula from perifistulous fibrosis in close vicinity to the ureteral opening, tension-free closure of the larger defect and occasional absence of omentum for use as interposition tissue. RESULTS: The average size of supratrigonal fistulas was 3.0 cm. Mean operative time was 141 minutes (range 110 to 160). Mean blood loss was 90 cc. No significant intraoperative or postoperative complications were observed. Mean hospital stay was 3 days. The catheter was removed 14 days postoperatively. All patients had a successful outcome. CONCLUSIONS: Our experience suggests that robotic repair for recurrent vesicovaginal fistulas is feasible, results in low morbidity and provides outstanding results. It provides an attractive option for vesicovaginal fistula repair by a minimally invasive approach for the surgeon and the patient alike.
Authors:
Ashok K Hemal; Surendra B Kolla; Pankaj Wadhwa
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Publication Detail:
Type:  Journal Article     Date:  2008-07-17
Journal Detail:
Title:  The Journal of urology     Volume:  180     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-08-11     Completed Date:  2008-09-18     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  981-5     Citation Subset:  AIM; IM    
Affiliation:
All India Institute of Medical Sciences, New Delhi, India. ahemal@wfubmc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Cystoscopy
Female
Humans
Hysterectomy
Postoperative Complications
Reconstructive Surgical Procedures / methods*
Recurrence
Reoperation
Robotics*
Tissue Adhesions / surgery
Treatment Outcome
Vesicovaginal Fistula / surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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