Robotic-Assisted Early Repair of Vesicovaginal Fistula in a Colon Cancer Patient: A Case Report and Surgical Technique Video.

introduction and hypothesisTo demonstrate the feasibility and technical approach of early robotic-assisted vesicovaginal fistula (VVF) repair in a patient with newly diagnosed colon cancer requiring timely initiation of chemotherapy following surgical resection.

methodsA stepwise robotic-assisted transperitoneal extravesical VVF repair was performed at a tertiary-care academic medical center through multidisciplinary collaboration between the Departments of Obstetrics and Gynecology and Urology. The procedure was conducted 6 weeks after the patient's initial oncologic surgery and included identification and excision of the fistula tract, dissection of the vesicovaginal space, layered closure of the bladder and vagina and interposition of an omental flap.

resultsThe surgery was completed robotically without intraoperative complications. Operative time was 4 h and 8 min with an estimated blood loss of 200 mL. The patient was discharged on postoperative day 3 in stable condition. Follow-up cystoscopic evaluation confirmed successful fistula closure without recurrence, allowing initiation of adjuvant chemotherapy.

conclusionEarly robotic-assisted VVF repair was technically feasible and resulted in successful fistula closure in this carefully selected patient requiring timely continuation of oncologic treatment. The repair incorporated careful patient selection, excision of devitalized tissue, tension-free multilayer closure and vascularized omental interposition, with no recurrence at 2 years. This case highlights the potential role of a multidisciplinary robotic approach in selected patients, while larger studies are needed to better define its safety, reproducibility and optimal indications.