title: Robotic repair of vesicovaginal fistulae with the transperitoneal-transvaginal approach: a case series.
abstract: OBJECTIVE
  To describe a novel technique of repairing the VVF using the transperitoneal-transvaginal approach.
  
  
  METHODS
  From June 2011 to October 2013, four patients with symptoms of urine leakage in the vagina underwent robotic repair of VVF with the transperitoneal-transvaginal approach. Cystoscopy revealed the fistula opening on the bladder. A ureteral stent was placed through the fistulous tract. After trocar placement, the omental flap was prepared and mobilized robotically. The vagina was identified and incised. The fistulous tract was excised. Cystorrhaphy was performed in two layers in an interrupted fashion. The vaginal opening was closed with running stitches. The omentum was interposed and anchored between the bladder and vagina. Finally, the ureteral catheters were removed in case they have been placed, and an 18 Fr urethral catheter was removed on the 14th postoperative day.
  
  
  RESULTS
  The mean age was 46 years (range: 41 to 52 years). The mean fistula diameter was 1.5 cm (range 0.3 to 2 cm). The mean operative time was 117.5 min (range: 100 to 150 min). The estimated blood loss was 100 mL (range: 50 to 150 mL). The mean hospital stay was 1.75 days (range: 1 to 3 days). The mean Foley catheter duration was 15.75 days (range: 10 to 25 days). There was no evidence of recurrence in any of the cases.
  
  
  CONCLUSIONS
  The robot-assisted laparoscopic transperitoneal transvaginal approach for VVF is a feasible procedure when the fistula tract is identified by first intentionally opening the vagina, thereby minimizing the bladder incision and with low morbidity.
authors.affiliation: Robotic and Minimally Invasive Surgery Center, Instituto Médico La Floresta Caracas - Venezuela.
authors.forename: Luciano A Nunez
authors.initials: LA
authors.lastname: Bragayrac
authors.affiliation: University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
authors.forename: Raed A
authors.initials: RA
authors.lastname: Azhar
authors.affiliation: Robotic and Minimally Invasive Surgery Center, Instituto Médico La Floresta Caracas - Venezuela.
authors.forename: Golena
authors.initials: G
authors.lastname: Fernandez
authors.affiliation: Robotic and Minimally Invasive Surgery Center, Instituto Médico La Floresta Caracas - Venezuela.
authors.forename: Marino
authors.initials: M
authors.lastname: Cabrera
authors.affiliation: Robotic and Minimally Invasive Surgery Center, Instituto Médico La Floresta Caracas - Venezuela.
authors.forename: Eric
authors.initials: E
authors.lastname: Saenz
authors.affiliation: Robotic and Minimally Invasive Surgery Center, Instituto Médico La Floresta Caracas - Venezuela.
authors.forename: Victor
authors.initials: V
authors.lastname: Machuca
authors.affiliation: Robotic and Minimally Invasive Surgery Center, Instituto Médico La Floresta Caracas - Venezuela.
authors.forename: Robert de
authors.initials: Rd
authors.lastname: Andrade
authors.affiliation: Robotic and Minimally Invasive Surgery Center, Instituto Médico La Floresta Caracas - Venezuela.
authors.forename: Oswaldo
authors.initials: O
authors.lastname: Carmona
authors.affiliation: Robotic and Minimally Invasive Surgery Center, Instituto Médico La Floresta Caracas - Venezuela.
authors.forename: Rene
authors.initials: R
authors.lastname: Sotelo
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D015203:Reproducibility of Results; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods; D014719:Vesicovaginal Fistula / Q000601:surgery*