Single Port Robotic Extravesical Vesicovaginal Fistula Repair With Omental Interposition
Background: A 44-year-old woman developed a vesicovaginal fistula following hysterectomy complicated by cystotomy.
Technique: This video demonstrates single-port robotic extravesical repair through an umbilical transperitoneal approach. Key steps include adhesiolysis, separation of the posterior bladder from the anterior vaginal wall, separate closure of the bladder and vaginal defects, cystoscopic confirmation of bilateral ureteral efflux, and omental flap interposition with fixation.
Outcome: The patient was discharged on postoperative day one. At two weeks, CT cystography showed no extravasation, the catheter was removed, and urinary leakage had resolved. She reportedly did not return for subsequent urology follow-up; long-term outcomes are unavailable.
Significance: The video illustrates an option for selected patients and adds technical detail to the limited SP VVF literature without establishing durable success or superiority over other approaches.
No conflicts to disclose
1. Thompson JC, Halder GE, Jeppson PC, et al. Repair of vesicovaginal fistulae: a systematic review. Obstet Gynecol. 2024;143(2):229-241. doi:10.1097/AOG.0000000000005468. https://doi.org/10.1097/AOG.0000000000005468
2. Randazzo M, Lengauer L, Rochat CH, et al. Best practices in robotic-assisted repair of vesicovaginal fistula: a consensus report from the European Association of Urology Robotic Urology Section Scientific Working Group for Reconstructive Urology. Eur Urol. 2020;78(3):432-442. doi:10.1016/j.eururo.2020.06.029. https://doi.org/10.1016/j.eururo.2020.06.029
3. Billah MS, Stifelman M, Munver R, Tsui J, Lovallo G, Ahmed M. Single port robotic assisted reconstructive urologic surgery-with the da Vinci SP surgical system. Transl Androl Urol. 2020;9(2):870-878. doi:10.21037/tau.2020.01.06. https://doi.org/10.21037/tau.2020.01.06
4. Cannoletta D, Pellegrino A, Pettenuzzo G, et al. Single-port transvesical vesico-vaginal fistula repair: an initial experience. Int Braz J Urol. 2024;50(4):502-503. doi:10.1590/S1677-5538.IBJU.2024.0146. https://doi.org/10.1590/S1677-5538.IBJU.2024.0146
5. Kim WB, Lee SW, Lee KW, Kim JM, Kim YH. Single-port robot-assisted vesicovaginal fistula repair via pneumovesicum approach. Theater Endourol Robot. 2025;1(1):17-20. doi:10.64364/tier.10101. https://doi.org/10.64364/tier.10101
6. Min KC, Lee CU. Single-port robot-assisted transperitoneal vesicovaginal fistula repair with omental flap interposition. Theater Endourol Robot. 2026;2(1):44-47. doi:10.64364/tier.26.0004. https://doi.org/10.64364/tier.26.0004
7. Jeon BJ, Tae BS, Park JY, Bae JH. Robotic pneumovesical vesicovaginal fistula repair using the da vinci sp system: technical feasibility and early outcomes. World J Urol. 2026;44:605. doi:10.1007/s00345-026-06421-1. https://doi.org/10.1007/s00345-026-06421-1
8. Fan X, Ma X, Lai Y, Li Z, Huang J, Huang H. Suprapubic transvesical repair of vesicovaginal fistula using a homemade laparoscopic single-port device: experience of 42 patients. Front Surg. 2021;8:744226. doi:10.3389/fsurg.2021.744226. https://doi.org/10.3389/fsurg.2021.744226
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