Transvesicoscopic Bipolar Sealing of Vesicovaginal Fistula

Abstract

Introduction & Objectives: Options for treatment of vesicovaginal fistula (VVF) consist of transabdominal, transvaginal, transvesical, laparoscopic and robotic repair or minimally invasive methods such as fulguration. We describe a novel minimally invasive tecnique “Transvesicoscopic bipolar sealing of vesicovaginal fistula (TBSF)” on 5-mm in diameter vesicovaginal fistula on a 46-year-old woman. Materials & Methods: Surgical Technique: The operation was conducted with the patient in the lithotomy position under spinal anesthesia. Prophylactic antibiotic was given half an hour before the induction. First vesicovaginal fistula was identified with a cystoscope using insufflation of gas and it was verified by a guide wire (A). The vagina was packed with vaseline soaked gauze to prevent leakage during bladder filling and escape of CO2 during vesicoscopy. A 5mm laparoscopic port was placed into the bladder under cystoscopic guidance in laterally of midline, halfway between the umbilicus and symphysis pubis. The second 5mm port was placed into the bladder in laterally of midline and inferior to the first port (B). A cystoscope was used as the transurethral camera for vesicoscopy. Bladder mucosa and muscular layer was griped with a forceps and raised up for a multilayer closure. The fistula tract was grasped and sealed by an EBVS (LigaSure™ 5 mm blunt tip 37 cm sealer, Medtronic, Inc, Dublin, Ireland) (C). An 18 Fr Ryle's tube was kept in the bladder as a cystostomy through one of the existent ports. The bladder was also catheterised. Results: The operative time was 65 minutes. The blood loss was minimal and could not be measured in the case. There were no intraoperative or postoperative complications. The patient was started orally within 3 hours, was allowed to move within 12 hours postoperatively and was discharged after removal of the cystostomy on the first postoperative day. Oral anticholinergic was given till the removal of foley catheter. Patient was instructed to return to our office 3 weeks after surgery for urethral foley catheter removal and subsequent cystoscopic and vaginal inspection to confirm VVF repair (D). During a 3-month follow-up, the patient remained continent, and laboratory results were within normal range. Conclusions: In select cases of vesicovaginal fistula, TBSF may be effectively used for closure to fistula tract. (Figure presented) .