title: Transanal Minimally Invasive Surgery (TAMIS) to Treat Vesicorectal Fistula: A New Approach.
abstract: OBJECTIVE
  Vesicorectal fistula is one of the most devastating postoperative complications after radical prostatectomy. Definitive treatment is difficult due to morbidity and recurrence. Despite many options, there is not an unanimous accepted approach. This article aimed to report a new minimally invasive approach as an option to reconstructive surgery.
  
  
  METHODS
  We report on Transanal Minimally Invasive Surgery (TAMIS) with miniLap devices for instrumentation in a 65 year old patient presenting with vesicorectal fistula after radical prostatectomy. We used Alexis® device for transanal access and 3, 5 and 11 mm triangulated ports for the procedure. The surgical steps were as follows: cystoscopy and implant of guide wire through fistula; patient at jack-knife position; transanal access; Identification of the fistula; dissection; vesical wall closure; injection of fibrin glue in defect; rectal wall closure.
  
  
  RESULTS
  The operative time was 240 minutes, with 120 minutes for reconstruction. No perioperative complications or conversion were observed. Hospital stay was two days and catheters were removed at four weeks. No recurrence was observed.
  
  
  CONCLUSIONS
  This approach has low morbidity and is feasible. The main difficulties consisted in maintaining luminal dilation, instrumental manipulation and suturing.
authors.affiliation: Programa de Cirurgia Urológica Minimamente Invasiva, Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil.|Seção de Uro-oncologia, Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil.
authors.forename: Marcos
authors.initials: M
authors.lastname: Tobias-Machado
authors.affiliation: Programa de Cirurgia Urológica Minimamente Invasiva, Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil.|Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil.
authors.forename: Pablo Aloisio Lima
authors.initials: PA
authors.lastname: Mattos
authors.affiliation: Divisão de Urologia da Faculdade de Ciências Médicas da Universidade de Campinas, UNICAMP, Campinas, Brasil.|Faculdade de Medicina - Divisão de Urologia do Centro de Ciências da Vida, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Brasil.
authors.forename: Leonardo Oliveira
authors.initials: LO
authors.lastname: Reis
authors.affiliation: Programa de Cirurgia Urológica Minimamente Invasiva, Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil.|Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil.
authors.forename: César Augusto Braz
authors.initials: CA
authors.lastname: Juliano
authors.affiliation: Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil.
authors.forename: Antonio Carlos Lima
authors.initials: AC
authors.lastname: Pompeo
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000601:surgery; D006801:Humans; D008297:Male; D008488:Medical Illustration; D061646:Operative Time; D011183:Postoperative Complications / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects; D012003:Rectal Fistula / Q000209:etiology / Q000601:surgery*; D015203:Reproducibility of Results; D000067368:Transanal Endoscopic Surgery / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D001747:Urinary Bladder Fistula / Q000209:etiology / Q000601:surgery*