title: Robotic assisted laparoscopic repair of vesico-vaginal fistula:  the extravesical approach.
abstract: The optimal method of vesico-vaginal fistula (VVF) repair remains undetermined.  Almost all previous descriptions of laparoscopic/robotic fistula repair involve utilizing a vertical cystotomy to identify the fisula.  Avoidance of an intravesical approach to vesico-vaginal fistula repair may decrease patient morbidity.  Patient selection, patient positioning, fistula recognition, port placement, intra-operative dissection techniques, flap formation, and repair are outlined in this video of robotic repair of vesico-vaginal fistula utilizing an extravesical approach.  The extravesical robotic repair has been successfully utilized in two patients with VVF following hysterectomy.  This manuscript and video demonstrates that vesico-vaginal fistulae can be repaired with a robotic assisted extravesical approach avoiding the morbidity of a large cystotomy.
authors.affiliation: Department of Urology, Mayo Clinic Florida, Jacksonville, Florida, USA.
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Rogers
authors.forename: David D
authors.initials: DD
authors.lastname: Thiel
authors.forename: Theodore E
authors.initials: TE
authors.lastname: Brisson
authors.forename: Steven P
authors.initials: SP
authors.lastname: Petrou
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D012371:Robotics / Q000379:methods*; D014719:Vesicovaginal Fistula / Q000601:surgery*