Transvesicoscopic Bipolar Sealing of Vesicovaginal Fistula

Pneumovesical vesicovaginal fistula repair: Lessons learned from an initial series of 25 patients

OBJECTIVES

This study aims to share the experiences and outcomes of laparoscopic pneumovesical repair for vesicovaginal fistulas (VVF).

MATERIALS AND METHODS

A retrospective review of medical records from a single institution over 10 years was conducted. The focus was on patients who underwent VVF repair using a pneumovesical approach with three 5 mm laparoscopic ports. The study evaluated perioperative parameters, postoperative outcomes, and complication rates to assess the efficacy and safety of this surgical method. Cumulative sum (CUSUM) analysis was used to determine the learning curve based on operative time.

RESULTS

Of the 26 patients with VVF, 23 (88.5%) had successful fistula closure after the first surgery. One patient required open surgery conversion due to challenges in maintaining pneumovesicum, and two experienced recurrences, although successful repairs were achieved in subsequent surgeries. The average patient age was 47.4 years, with a mean operative time of 99.9 min. The postoperative hospital stay averaged 9.1 days, and catheterization lasted about 11 days. The CUSUM chart indicated a learning curve, with fluctuations until the 19th case, followed by a consistent upward pattern.

CONCLUSION

Laparoscopic pneumovesical VVF repair is an effective and safe technique, especially suitable for fistulas near the ureteral orifice or deep in the vaginal cavity. The method demonstrates favorable outcomes with minimal complications and allows for easy reoperation if necessary.

Natural Orifice Transurethral Endoscopic Vesicovaginal Fistula (NOTE-VVF) Treatment for Early and Small Fistulas: Case Report and the Point of Technique

Minimally invasive surgical approaches have become highly popular in line with technological advancements. In vesicovaginal fistula (VVF) repair, numerous minimally invasive surgical techniques have been described, namely, laparoscopic, robotic, and transvaginal techniques, and used. However, these techniques still require invasiveness. In this report, we present a patient with iatrogenic VVF on whom we applied a novel “zero-incision” technique, Natural Orifice Transurethral Endoscopic Vesicovaginal Fistula (NOTE-VVF) treatment, to repair the fistula tract by advancing the laparoscopic trocar through a natural orifice, i.e., urethra. 

Intravesical repair of vesicovaginal fistula guided by cystoscopy

Background

Vesicovaginal fistulas (VVF) are an unusual problem that may significantly affect a patient's quality of life. The main causes for this condition are labour complications (mostly in developing countries) and pelvic surgeries (in industrialised countries). Treatment may be conservative or surgical. Regarding surgical treatment, there is still debate about the best approach and surgical technique.

Objective

To demonstrate a correction of a VVF guided by cystoscopy using intravesical laparoscopic instruments.

Methods

Case report and surgical video of a recurrent VVF treated with a hybrid technique involving direct transvesical insertion of 3 mm laparoscopic trocars and instruments guided by cystoscopy. As far as we know, although there are some reported techniques that use a combination of transvesical laparoscopic instruments and cystoscopy, this is the least invasive and most ergonomic technique described.

Results

Two years after surgery, the patient remains asymptomatic and with no fistula recurrence.

Conclusion

The transvesical approach guided by cystoscopy seems to be an effective, safe and ergonomic minimally invasive procedure for VVF repair.