Robot-assisted laparoscopic repair of rare post-cesarean section vesicocervical and vesicouterine fistula: a case series of a novel technique.

Objective: To present experience with robotic repair of complex vesicouterine fistula (VUF) and vesicocervical fistula (VCF) in 3 patients and to describe technique of repair with 18-months follow-up.

Methods: Three patients were diagnosed with VUF or VCF. Two patients had prior history of lower segment cesarean section complicated by bladder injury and the third had difficult labor with vaginal birth after previous cesarean section. Preoperative diagnosis of VUF/VCF was based on classical history, cystoscopy, and imaging studies. All patients underwent pure robotic repair of fistula. The steps of the technique of repair include cystoscopy, bilateral temporary ureteral catheterization, placement of ports, adhesiolysis, separation of bladder and uterus or cervix, closure of bladder and uterus or cervix and omental interposition.

Results: Robotic repair was successful in all patients. There were no intraoperative and postoperative complications. All patients were ambulatory on day 1 and were discharged on day 2. Foley catheter was removed after 2 weeks and all patients were followed over 18 months.

Conclusion: This technique demonstrates robotic repair of rare VCF and VUF performed safely and effectively. The robotic assistance helped in complex dissection and reconstructive steps. This approach is an excellent minimally invasive alternative at centers with robotic technology because these fistulae cannot be repaired vaginally. Experience of the team is important in managing such cases.