Robot-assisted vesicovaginal fistula repair with “Rainbow-shaped” peritoneal flap: a single-center experience

Abstract

PURPOSE: Vesicovaginal fistula (VVF) refers to an abnormal communication between the bladder and vagina, leading to uncontrolled leakage of urine from the vagina. This study aimed to assess the efficacy and safety of robot-assisted laparoscopic VVF repair with a "rainbow-shaped" peritoneal flap. METHODS: A retrospective analysis was conducted on 15 patients who underwent robot-assisted VVF repair from July 2021 to March 2023 in Peking University First Hospital. The patient cohort included 1 patient who had undergone abdominal total hysterectomy, 11 patients who had laparoscopic total hysterectomy, 1 patient who had cervical conization, and 2 adolescents with residual intravaginal foreign bodies. RESULTS: Seven had a history of failed VVF repair, while 8 underwent primary repair. The mean operative time was 137 (range 92-182) min, and the mean hospital stay was 4.9 (range 4.3-5.5) days. Surgical blood loss was minimal, averaging 14 (range 6-22) ml. The fistula was located supratrigonal in 14 patients and in the triangle area in one patient. In the vagina, the fistulas were located at the stump in 12 patients, at the anterior vaginal wall in one patient, and at the vaginal wall with partial involvement of the cervix in two patients. All procedures were successfully completed without the need for open conversion. All 15 patients achieved successful repair, with no complications reported during the mean follow-up period of 7.8 months. CONCLUSION: Robot-assisted laparoscopic repair with a "rainbow-shaped" peritoneal flap for VVF is an effective, safe, and highly successful technique.