Robot-assisted laparoscopic repair of injuries to bladder and ureter following gynecological surgery and obstetric injury

Abstract

INTRODUCTION: The objective of the study is to evaluate the outcome of robot-assisted laparoscopic repair of injuries to urinary tract following gynecological surgery and obstetric injury. METHODS: This retrospective analysis from prospectively collected data of repair of injuries to bladder and ureter using da Vinci Si robotic platform was carried out. Between April 2014 and May 2019, 27 patients were operated on in a single surgical unit; 25 had hysterectomy and 2 were obstetric cases. Fifteen patients underwent vesicovaginal fistula (VVF) repair, ten underwent ureteral reimplant, with concomitant psoas hitch, and two underwent Boari flap repair following gynecological surgery and obstetric injury. RESULTS: Among 15 patients of VVF repair, 3 cases were previously attempted failed repair, 2 underwent concomitant ureteral reimplant, and 1 underwent concomitant ovarian cystectomy. The mean total operative time was 126 (75-206) min, and the mean hospital stay was 4.4 (3-6) days. Among 12 cases of ureteral injury, 5 were on the right side and 7 were on the left side; the mean total operative time was 150.16 (110-215) min, and the mean hospital stay was 4 (3-7) days. No case required conversion to open in this cohort. All cases were successfully cured without any recurrence of fistula or stricture during their mean follow-up period of 35.3 (9-66) months. CONCLUSIONS: Robot-assisted laparoscopic repair for injuries to bladder and ureter is effective and highly successful even in previously failed cases.