Autores: René Sotelo, David Canes, Robert De Andrade, Oswaldo Carmona, Camilo Guidelman, Rafael Clavijo , Golena Fernández, Roberto Garza, Juan Castro, Roberto Cisneros
Sub-case: Complex Fistula > 2.5cm, VVF and ureteral injury. Patient: 46 years old female s/p abdominal hysterectomy for benign disease 4 years ago.
Technique: Identification of the vesicovaginal fistulous tract. Dissection of both structures involved. Vaginal Closure. Omental flap interposition and bladder closure . Left ureter reimplanted.
Results: Operative time: three hours. Blood loss: between 200-300 cc. Hospital stay: three days. Foley Catheter removed after 30 days. Follow up one month. No recurrence.
Sub-case: Robotic Repair of Complex Vesico Vaginal Fistule and Colo-Vesical Fistulae. Patient: 72 years old female s/p radical hysterectomy 30 years ago. Received radiation therapy. Loss of urine per vagine for past six years. Diarrhea for the last two years.
Technic: Cystoscopy to pass wires through both fistulous tracts. Appropriate imaging to identify the fistulous tracts. Vesicotomy. Colovesical fistula identification. Bladder and colon dissection. Closure of colon. Vesicovaginal fistula identification. Dissection of the vaginal and bladder wall. Closure of the vagina. Omental flap interposition and bladder closure. Transient loop ileostomy.
Results: Operative time: three hours. Blood loss: between 200-300 cc. Hospital stay: three days. Foley Catheter after 15 days. Follow up one month. No recurrence.
Advantages of Robotic Repair of Complex Vesico Vaginal Fistule: Shorter hospitalization. Reduced pain and discomfort. Reduced blood loss and transfusions.
Conclusions: Da Vinci Robotic System allows successful identification of the correct tissue plans for appropriate dissection and help in suturing during the repair of fistula. This technique can be employed for the efficacious repair of complex fistulae.