Robotic Repair of Complex Vesicouterine Fistula with and without Hysterectomy

Objective: To present robotic repair of vesicouterine fistulae (VUF) with and without hysterectomy in 3 cases and to discuss the technique with its outcome. Methods: Three patients were diagnosed with VUF, of whom 2 had a prior history of multiple cesarean sections and 1 had obstructed labor. Preoperative diagnosis of VUF was based on classic history, cystoscopy and imaging studies. All patients underwent pure robotic repair of VUF with hysterectomy in 1 case. The steps of the technique are cystoscopy, bilateral ureteral catheterization, port placement, adhesiolysis, separation of bladder and uterus and excision of the VUF with freshening of margins, closure of the uterus and bladder, hysterectomy in 1 case, and omental interposition. Results: Robotic repair of VUF was successful in all cases with mean operative time of 127.5 min and average blood loss of 120 ml. One patient underwent simultaneous robotic hysterectomy. All patients were ambulatory on day 1 and were discharged on day 3 with indwelling Foley’s catheter, which was removed on day 10. Conclusion: Robotic repair of VUF is safe and effective with successful outcome in all cases and has all the advantages of open and laparoscopic surgery. If required, concomitant robotic hysterectomy can also be performed. This is the first case series in the world.