Vesico-Vaginal Fistula (VVF) repair remains a challenge not only for its complexity but also the onus of failure is high as it affects both the social and psychological wellbeing of the patient. Therefore the operating surgeon has to give best possible results. Because of this and complexity of laparoscopic reconstruction, open surgical approach had been the modality of choice until now.
However in open surgery, one has to go through the previous scar, long cystotomy incision, postoperative pain and delayed postoperative recovery. The transvaginal repair circumvents few of these problems, however in complex situations such as supratrigonal large fistula, narrow scarred vagina, requirement of adjunct procedures (ureteric reimplantation), previous failed transvaginal repairs, it is not a desirable approach. Robotic assistance offers distinct advantage in all such situations thus offering the chance of application of minimal invasive approach without compromising the outcomes. Moreover it enables the surgeon to perform any adjunct procedures like uretreric reimplantation, cercicoplasty, uterine preservation etc. The present paper highlights the feasibility and safety of Robot assisted repairs of VVF. The paper is the largest series of Robotic VVF repair and describes the technique for successful outcomes.
Written by: Dr Ravimohan S. Mavuduru, MS, MCh, MAMS