{"paper_id":"84cdaf16-21aa-4c0b-ad26-176bbefb3819","body_text":"Abstract\nStudy Objective\nTo demonstrate, via robotic-assisted laparoscopy, a transperitoneal technique for repair of post-hysterectomy vesicovaginal fistula (VVF) using an omental interposition flap.\nDesign\nVideo article.\nSetting\nUniversity Hospital and referral center for Gynaecological disease.\nPatients or Participants\nA 52-year-old woman with VVF after laparoscopic hysterectomy.\nInterventions\nRepair of post-hysterectomy VVF with omental flap interposition.\nMeasurements and Main Results\nA 52-year-old woman with a history of menorrhagia refractory to medical treatment underwent a total laparoscopic hysterectomy and bilateral salpingectomy. Histology of the uterus showed multiple uterine fibroids and adenomyosis. Twelve days following the hysterectomy, she developed leakage of urine per vagina. Computed tomography scan and cystourethrogram demonstrated normal ureters and presence of a vesicovaginal fistula. An indwelling catheter was inserted to rest the bladder and allow the acute inflammation surrounding the fistula to subside prior to definitive surgical repair six weeks later. The repair consisted of seven steps:\n-\n1.\nRestoration of anatomy\n-\n2\nOpening the vaginal vault\n-\n3\nIdentification of fistula defect\n-\n4\nResection of fistula tract\n-\n5\nDissection of vesicovaginal space\n-\n6\nClosure of vesical and vaginal defects\n-\n7\nInterposition of omental graft\nThe patient was discharged 48 hours after surgery. The indwelling catheter was maintained for 14 days. Cystourethrogram was carried out to confirm the integrity of the bladder prior to catheter removal. There was no further vaginal loss. Clinical follow up at six weeks and three months post-repair showed no bladder or vaginal dysfunction.\nConclusion\nRobotic-assisted laparoscopy is a feasible approach for repair of VVF, which can be performed systematically using seven steps. This technology lends itself well to procedures requiring intricate dissection and multi-layered suturing as demonstrated in this case.","source_license":"CC0","license_restricted":false}