Robot-Assisted,Extraperitoneal Transvesical Repair of a Colovesical Fistula

Abstract

Introduction:

Colovesical fistula is a rare, but well-recognized complication of abdominopelvic surgery, diverticular disease, and pelvic radiation therapy. Management is often challenging and usually requires open surgical repair if endoscopic techniques fail. We present repair of a colovesical fistula from a Hartmann's pouch to the posterior bladder using a transvesical robotic approach in a patient with prior history of multiple open abdominal and pelvic procedures.

Materials and Methods:

We present a video describing our technique. The key elements to our approach were as follows. (1) Cystoscopy to identify the fistula and assist in direct port placement. (2) Replacement of saline with CO₂. (3) The patient was placed in a slight Trendelenburg position during the surgery and the robot was docked between the patient's legs with a 10-mm camera port and two 8-mm robotic ports used. (4) Suction is attached to the Foley catheter and used as needed for visualization. (5) Suture was introduced and the specimen was removed using the robotic arm trocar.

Results:

The case was uncomplicated with an operative time of 123 minutes. The estimated blood loss was <10 mL. The patient recovered as expected, requiring only 20 mg morphine equivalents. He was discharged from the hospital on postoperative day 1. Follow-up cystoscopy revealed scarring at the site of repair, but the fistula was closed. A cystogram was performed and no fistula was visualized.

Conclusion:

The described technique provided a minimally invasive extraperitoneal approach with excellent visualization and access to the colovesical fistula in a patient who had a history of multiple abdominal and pelvic surgeries. Morbidity was low and the outcome was excellent. The views and opinions expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.

No competing financial interests exist.

Runtime of video: 5 mins 34 secs