title: Robot-assisted extravesical vesicovaginal fistula repair utilizing laparoscopically mobilized omental flap interposition.
abstract: OBJECTIVE
  High vesicovaginal fistulas (VVF) in the setting of good apical support are best repaired via a transabdominal approach. Laparoscopic VVF repair was first reported in 1998. Several series of robot-assisted VVF repairs have since been published. The robot-assisted approach allows repair of high apical vaginal fistulas while avoiding the morbidity of laparotomy, shortening convalescence, and facilitating the use of omental interposition flaps. This video presents the technique for robot-assisted extravesical VVF repair utilizing a laparoscopically mobilized omental flap.
  
  
  METHODS
  A 43-year-old woman developed a VVF after a total abdominal hysterectomy for fibroids. Pre-operative CT urogram and office cystoscopy confirmed the diagnosis and ruled out ureteral involvement. She underwent a robot-assisted extravesical VVF repair utilizing a laparoscopically mobilized omental flap.
  
  
  RESULTS
  The surgery was uncomplicated, and the patient was discharged on post-operative day 1. A cystogram 2 weeks post-operatively revealed no evidence of a fistula. At 3 months follow-up, the patient denied any urinary incontinence.
  
  
  CONCLUSIONS
  Robot-assisted extravesical VVF repair avoids the morbidity of a laparotomy, provides excellent exposure, and avoids a large cystotomy. It maintains vaginal length and allows for significantly better visualization compared with the transvaginal approach. This repair offers improved outcomes for certain patients depending on their history, anatomy, and the surgeon's experience.
authors.affiliation: Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, 1250 Waters Place, Tower One, 7th Floor, Bronx, NY, 10461, USA. Kara.Watts@gmail.com.
authors.forename: Kara L
authors.initials: KL
authors.lastname: Watts
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Ho
authors.affiliation: Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, 1250 Waters Place, Tower One, 7th Floor, Bronx, NY, 10461, USA.
authors.forename: Reza
authors.initials: R
authors.lastname: Ghavamian
authors.affiliation: Department of Urology, Montefiore Medical Center and Albert Einstein College of Medicine, 1250 Waters Place, Tower One, 7th Floor, Bronx, NY, 10461, USA.
authors.forename: Nitya
authors.initials: N
authors.lastname: Abraham
mesh_terms: D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D009852:Omentum / Q000637:transplantation; D012371:Robotics; D013524:Surgical Flaps; D014719:Vesicovaginal Fistula / Q000601:surgery*
keywords: Omental flap; Robotic; Vesicovaginal fistula