title: Robot-assisted vesicovaginal fistula repair: a safe and feasible technique.
abstract: OBJECTIVE
  Open transabdominal repair of vesicovaginal fistula (VVF) requires a long cystotomy incision, suprapubic drainage and delayed recovery. Laparoscopic repair is limited by difficult suturing in pelvic procedures. Therefore, the utility of robotic assistance is being increasingly explored. We share our initial experience of robot-assisted laparoscopic VVF repair.
  
  
  METHODS
  The data from patients who underwent robot-assisted VVF repair from December 2014 to August 2016 were recorded and analyzed. Patients underwent standard preoperative evaluation. After cystovaginoscopy and placement of an access catheter across the fistula, a four-port transperitoneal approach was used. Following adhesiolysis, limited posterior cystotomy was performed. The vaginal and bladder flaps were separated and repaired in the transverse and vertical directions, respectively. V-Loc sutures were used for bladder closure. Omental/sigmoid colon epiploicae or a peritoneal flap was interposed. A pelvic drain was placed.
  
  
  RESULTS
  During the study period, 30 patients underwent surgery, of whom 11 (36.7 %) had complex VVF (9 with failure of a previous repair, 1 following radiotherapy, and 1 with a large defect following obstructed labor), and 27 had supratrigonal VVF. The mean age of the patients was 43.5 ± 8.6 years. The mean operative time was 133 ± 48 min. Median blood loss was 50 ml (IQR 50 ml). No suprapubic catheter was placed. The median durations of drain placement and hospital stay were 3 days (IQR 2 days) and 7.5 days (IQR 4.5 days), respectively. The median duration of follow up was 38 weeks (IQR 46 weeks). No recurrence was seen in 28 patients (93.3 %).
  
  
  CONCLUSIONS
  Current data suggest that robot-assisted VVF repair is safe and feasible and probides the advantages of minimally invasive surgery.
authors.affiliation: Department of Urology, PGIMER, Chandigarh, India, 160012.
authors.forename: Girdhar S
authors.initials: GS
authors.lastname: Bora
authors.affiliation: Department of Urology, PGIMER, Chandigarh, India, 160012.
authors.forename: Shivanshu
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Urology, PGIMER, Chandigarh, India, 160012. ravismi2003@yahoo.com.
authors.forename: Ravimohan S
authors.initials: RS
authors.lastname: Mavuduru
authors.affiliation: Department of Urology, PGIMER, Chandigarh, India, 160012.
authors.forename: Sudheer K
authors.initials: SK
authors.lastname: Devana
authors.affiliation: Department of Urology, PGIMER, Chandigarh, India, 160012.
authors.forename: Santosh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Urology, PGIMER, Chandigarh, India, 160012.
authors.forename: Uttam K
authors.initials: UK
authors.lastname: Mete
authors.affiliation: Department of Urology, PGIMER, Chandigarh, India, 160012.
authors.forename: Shrawan K
authors.initials: SK
authors.lastname: Singh
authors.affiliation: Department of Urology, PGIMER, Chandigarh, India, 160012.
authors.forename: Arup K
authors.initials: AK
authors.lastname: Mandal
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D010537:Peritoneum / Q000601:surgery; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D013524:Surgical Flaps; D013537:Sutures; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods*; D014719:Vesicovaginal Fistula / Q000601:surgery*
keywords: Case series; Robotic surgery; Vesicovaginal fistula