Mahadevappa Nagabhushana, Gudage Swathi, Senguttavan Karthikeyan V, Mallya Ashwin, Dharwadkar Sachin
Department of Urology, Institute of Nephrourology, Victoria Hospital Campus, Bengaluru, Karnataka, India.
Department of OBG, Victoria Hospital, Bengaluru, Karnataka, India.
Urol Ann. 2016 Jul-Sep;8(3):305-11. doi: 10.4103/0974-7796.184896.
Vesicovaginal fistula (VVF) is a major complication with psychosocial ramifications. In literature, few VVF cases have been managed by laparoendoscopic single site surgery (LESS) and for the 1(st) time we report VVF repair by LESS using conventional laparoscopic instruments. We present our initial experience and to assess its feasibility, safety and outcome.
From March 2012 to September 2015, LESS VVF repair was done for ten patients aged between 30 and 65 (45.6 ± 10.15) years, who presented with supratrigonal VVF. LESS was performed by modified O'Conor technique using regular trocars with conventional instruments. Data were collected regarding feasibility, intra- or post-operative pain, analgesic requirement, complication, and recovery.
All 10 cases were completed successfully, without conversion to a standard laparoscopic or open approach. The mean operative time was 182.5 ± 32.25 (150-250) min. The mean blood loss was 100 mL. The respective mean visual analog score for pain on day 1, 2, and 3 was 9.2 ± 1, 5 ± 1, and 1.4 ± 2.3. The analgesic requirement in the form of intravenous tramadol on days 1, 2, and 3 was 160 ± 51.6, 80 ± 63.2, and 30 ± 48.3, mgs respectively. No major intra- or post-operative complications were observed. The mean hospital stay was 2.6 ± 0.7 (2-4) days.
In select patients, LESS extravesical repair of VVF using conventional laparoscopic instruments is safe, feasible with all the advantages of single port surgery at no added cost. Additional experience and comparative studies with conventional laparoscopy are warranted.
膀胱阴道瘘（VVF）是一种具有社会心理影响的主要并发症。在文献中，很少有膀胱阴道瘘病例通过腹腔镜单部位手术（LESS）进行治疗，我们首次报告使用传统腹腔镜器械通过LESS修复膀胱阴道瘘。我们介绍我们的初步经验，并评估其可行性、安全性和结果。
2012年3月至2015年9月，对10例年龄在30至65岁（45.6±10.15岁）之间、表现为膀胱三角上膀胱阴道瘘的患者进行了LESS膀胱阴道瘘修复术。LESS采用改良奥康纳技术，使用常规套管针和传统器械进行。收集了有关可行性、术中或术后疼痛、镇痛需求、并发症和恢复情况的数据。
所有10例手术均成功完成，未转为标准腹腔镜或开放手术。平均手术时间为182.5±32.25（150 - 250）分钟。平均失血量为100毫升。第1、2和3天疼痛的视觉模拟评分分别为9.2±1、5±1和1.4±2.3。第1、2和3天静脉注射曲马多形式的镇痛需求分别为160±51.6、80±63.2和30±48.3毫克。未观察到重大的术中或术后并发症。平均住院时间为2.6±0.7（2 - 4）天。
在特定患者中，使用传统腹腔镜器械进行LESS膀胱外修复膀胱阴道瘘是安全、可行的，具有单孔手术的所有优点且无需额外费用。需要更多经验以及与传统腹腔镜手术的对比研究。
