title: Robotic repair of rectovesical fistula resulting from open radical prostatectomy.
abstract: OBJECTIVE
  Rectovesical fistula (RVF) is a rare complication of radical prostatectomy. A 57-year-old man underwent open radical prostatectomy with recognized rectal injury, primary closure of the rectal wall, and loop colostomy. The patient developed urine leakage per rectum after colostomy closure. We diverted the fecal stream with end colostomy and placed a suprapubic tube. An open transsacral (Kraske) repair failed 1 month later. We have previously described the laparoscopic approach, and report the technique and results of our first robotic assisted operation.
  
  
  METHODS
  The operative steps were as follows: (1) cystoscopy, (2) RVF catheterization (3) five-port transperitoneal laparoscopic initial dissection (4) mobilization of omental pedicle flap, (4) cystotomy extending toward the fistulous tract, (5) robot docking (6) dissection of the rectovesical plane, (7) interrupted rectal closure, (8) omental interposition, (9) bladder closure, and (10) drain placement.
  
  
  RESULTS
  Operative time was 180 minutes. Hospital stay was 1 day. The suprapubic tube was removed at 2 months after normal cystography. Bowel continuity was restored at 4 months, with no fistula recurrence at 1-month follow-up.
  
  
  CONCLUSIONS
  We await longer follow-up and experience in larger series. For now, robotic repair of rectovesical fistula appears feasible and represents an attractive alternative to open and laparoscopic approaches.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA. renesotelo@mac.com
authors.forename: Rene
authors.initials: R
authors.lastname: Sotelo
authors.forename: Robert
authors.initials: R
authors.lastname: de Andrade
authors.forename: Oswaldo
authors.initials: O
authors.lastname: Carmona
authors.forename: Juan
authors.initials: J
authors.lastname: Astigueta
authors.forename: Alejandro
authors.initials: A
authors.lastname: Velasquez
authors.forename: Gustavo
authors.initials: G
authors.lastname: Trujillo
authors.forename: David
authors.initials: D
authors.lastname: Canes
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011467:Prostate / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000150:complications / Q000601:surgery*; D012003:Rectal Fistula / Q000601:surgery*; D012371:Robotics; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000295:instrumentation* / Q000379:methods