title: Vesicovaginal fistula repair without intentional cystotomy using the laparoscopic robotic approach: a case report.
abstract: OBJECTIVE
  Fistulas inaccessible from the vagina may require abdominal repair; we sought to evaluate the robotic-assisted laparoscopic approach for this procedure.
  
  
  METHODS
  A 41-year-old nulliparous woman presented with urinary incontinence following an abdominal hysterectomy, and office evaluation identified a vesicovaginal fistula. After discussion with the patient regarding the surgical options, the robotic approach was chosen to facilitate precise dissection, fine visualization, and suturing. A stent was placed from the bladder into the vagina, and no intentional cystotomy was made. The bladder was dissected away from the anterior vaginal wall at the fistula site, and the defects were closed independently with interposition of a fatty epiploica from the sigmoid colon. Total operative time was approximately 4 hours, and robotic time was about 2.5 hours.
  
  
  RESULTS
  At 3 months after surgery, the patient had no recurrent symptoms.
  
  
  CONCLUSIONS
  The robotic-assisted laparoscopic approach is a viable option for successful repair of a vesicovaginal fistula in a patient in whom a vaginal approach is not indicated.
authors.affiliation: Department of Obstetrics & Gynecology, Division of Urogynecology, Hartford Hospital, 85 Seymour Street, Hartford, CT 06106, USA. mschimp@harthosp.org
authors.forename: Megan O
authors.initials: MO
authors.lastname: Schimpf
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Morgenstern
authors.forename: Paul K
authors.initials: PK
authors.lastname: Tulikangas
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Wagner
mesh_terms: D000328:Adult; D053715:Cystotomy; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D010535:Laparoscopy; D012371:Robotics; D014719:Vesicovaginal Fistula / Q000209:etiology / Q000601:surgery*