Division of Minimally Invasive Gynecologic Surgery and Robotics (Drs. Wang, Mesbah, Wells, and Nezhat).
Division of Urogynecology (Dr. Lazarou), Obstetrics and Gynecology Department, New York University Winthrop Hospital, Mineola, New York.
J Minim Invasive Gynecol. 2021 May;28(5):942. doi: 10.1016/j.jmig.2020.08.484. Epub 2020 Aug 31.
To demonstrate intra- and postoperative steps in a successful management of a complicated vesico-[utero]/cervicovaginal fistula.
Stepwise demonstration of the technique with narrated video footage.
A urogenital fistula in developed countries mostly occurs after gynecologic surgeries but rarely from obstetric complications. The main treatment of a urogenital fistula is either transvaginal or transabdominal surgical repair. We present a case of a 36-year-old woman, gravida 3 para 3-0-0-3, who developed a complicated large vesico-[utero]/cervicovaginal fistula after an emergent repeat cesarean section. Robotic repair was performed 2 months after the injury using the modified O'Connor method. Blood loss was minimal, and the patient was discharged from the hospital 1 day postoperatively. Follow-up showed complete healing of the fistula with no urine leakage, frequency of urination, or dyspareunia. The patient resumed normal bladder function and menstrual period up to 4 months after the repair procedure.
The basic surgical principle of urogenital fistula repair is demonstrated: (1) development of vesicovaginal spaces by dissection of the bladder from the uterus and the vagina, (2) meticulous hemostasis, (3) adequate freshened of the fistula edges, (4) tension-free and watertight closure of the bladder. We also demonstrate some other techniques that have developed though our own practice: (1) facilitating bladder distention by temporarily blocking the fistula, (2) placement of a ureteral catheter to protect the ureters, (3) interposition with omental flap, (4) single layer through and through closure of a cystotomy with 2-0 V-Loc suture (Covidien, Irvington, NJ).
Complicated urogenital fistulas may be repaired successfully using minimally invasive surgery using robotic assistance, enabling less blood loss, faster recovery, shorter hospital stay, and fewer complications, etc.
展示成功处理复杂膀胱-子宫/宫颈阴道瘘的术中及术后步骤。
分步演示技术，并配有解说视频。
发达国家的泌尿生殖瘘大多发生于妇科手术后，但很少由产科并发症引起。泌尿生殖瘘的主要治疗方法是经阴道或经腹手术修复。我们报告了一例 36 岁的女性，孕 3 产 3-0-0-3，在紧急重复剖宫产术后发生复杂的大膀胱-子宫/宫颈阴道瘘。在损伤后 2 个月，采用改良的 O'Connor 法进行机器人修复。出血量少，患者术后 1 天出院。随访显示瘘完全愈合，无尿液漏出、尿频或性交困难。患者在修复术后 4 个月恢复正常膀胱功能和月经。
泌尿生殖瘘修复的基本手术原则如下：（1）通过从子宫和阴道分离膀胱来发展膀胱阴道间隙；（2）仔细止血；（3）充分修剪瘘口边缘；（4）膀胱无张力且密闭性缝合。我们还展示了一些通过我们自己的实践发展起来的其他技术：（1）通过暂时堵塞瘘口来促进膀胱扩张；（2）放置输尿管导管以保护输尿管；（3）网膜瓣移植；（4）使用 2-0V-Loc 缝线（Covidien，Irvington，NJ）单层连续缝合膀胱切开术。
使用机器人辅助的微创手术可以成功修复复杂的泌尿生殖瘘，从而减少出血量、加快恢复、缩短住院时间和减少并发症等。
