Robotic Vesicovaginal Fistula Repair

Repair of vescio-vaginal fistula (VVF) represents a surgical challenge with regards to timing of repair, surgical approach, and postoperative patient management (Urology, 160:1995–1999, 1998; Can J Urol, 19: 6474–6476, 2012). Vesicovaginal fistula (VVF) repair may be undertaken via open, laparoscopic, or vaginal approaches (Urology, 160:1995–1999, 1998). VVF below the trigone are usually repaired vaginally. Supratrigonal fistulas have been repaired utilizing open and laparoscopic/robotic approaches (Can J Urol, 19: 6474–6476, 2012). This is typically accomplished through an intravesical approach (Urology, 67:970–973, 2006; J Urol, 180:981–985, 2008). The extravesical approach to VVF repair has also been described for supratrigonal fistulas; this approach may improve the postoperative morbidity associated with a large cystotomy (Can J Urol, 19: 6474–6476, 2012). The following chapter will discuss the operative setup, positioning, trocar configuration, instrumentation, step-by-step technique, common complications, and follow-up for robotic-assisted VVF repair.