Robotic Repair of Complicated Vesico-[utero]/Cervicovaginal Fistula after Cesarean Section
| Autor: | George Lazarou, Pengfei Wang, Michael Mesbah, Mathew Wells, Farr Nezhat |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Fistula Urinary Bladder Vesicovaginal fistula Robotic Surgical Procedures Pregnancy medicine Humans Robotic surgery Surgical repair Vesicovaginal Fistula business.industry Cesarean Section Uterus Obstetrics and Gynecology medicine.disease Surgery Dissection medicine.anatomical_structure Vagina Female business Through and through |
| Zdroj: | Journal of minimally invasive gynecology. 28(5) |
| ISSN: | 1553-4669 |
| Popis: | Study Objective To demonstrate intra- and postoperative steps in a successful management of a complicated vesico-[utero]/cervicovaginal fistula. Design Stepwise demonstration of the technique with narrated video footage. Setting 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. Interventions 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). Conclusion 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. |
| Databáze: | OpenAIRE |
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