title: Robot-assisted Laparoscopic Repair of Vesicovaginal Fistula: A Single-center Experience.
abstract: OBJECTIVE
  To describe our surgical technique and outcomes with robot-assisted laparoscopic repair of vesicovaginal fistula (VVF) in 10 patients.
  
  
  METHODS
  From November 2010 to April 2014, a total of 10 patients with VVF underwent robot-assisted laparoscopic VVF repair. The principles of VVF repair were followed. The fistula tract was excised. The vagina defect and the cystotomy were closed with a flap of epiploica of sigmoid colon, a peritoneal inlay, or a bladder adventitia layer interposed between the bladder and vaginal suture lines. Perioperative patient characteristics, complications, operative data, and follow-up results were retrospectively reviewed with institutional review board approval.
  
  
  RESULTS
  All 10 patients developed VVF as a result of previous elective hysterectomies for benign indications. Mean operative time was 214 minutes (range, 120-457 minutes). Longer operative times were caused by concomitant surgeries (3 ureteral reimplantations and 1 planned sigmoid colectomy). Median length of stay was 1 day (range, 1-5 days). There were no intraoperative complications. Perioperatively, there was 1 Clavien-Dindo grade 1 complication (ileus), and 2 grade 2 complications (readmission with Clostridium difficile infection and atelectasis). All patients were cured and were without VVF recurrence at a median follow-up close to 2 years.
  
  
  CONCLUSIONS
  Robot-assisted laparoscopic VVF repair is an effective approach to manage VVF even in complex medical scenarios. It is anticipated that an increasing number of VVF repairs will be undertaken with robot-assisted approach in the future, offering more patients who need VVF repair the advantages of minimally invasive surgery.
authors.affiliation: Department of Urology, University of Rochester Medical Center, Rochester, NY.
authors.forename: Vineet
authors.initials: V
authors.lastname: Agrawal
authors.affiliation: Department of Urology, University of Rochester Medical Center, Rochester, NY.
authors.forename: Victor
authors.initials: V
authors.lastname: Kucherov
authors.affiliation: Department of Urology, Good Shepherd Medical Center, Longview, TX.
authors.forename: Emma
authors.initials: E
authors.lastname: Bendana
authors.affiliation: Department of Urology, University of Rochester Medical Center, Rochester, NY.
authors.forename: Jean
authors.initials: J
authors.lastname: Joseph
authors.affiliation: Department of Urology, University of Rochester Medical Center, Rochester, NY.
authors.forename: Hani
authors.initials: H
authors.lastname: Rashid
authors.affiliation: Department of Urology, University of Rochester Medical Center, Rochester, NY. Electronic address: guan_wu@urmc.rochester.edu.
authors.forename: Guan
authors.initials: G
authors.lastname: Wu
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D013520:Urologic Surgical Procedures / Q000379:methods; D014719:Vesicovaginal Fistula / Q000601:surgery*