Mediathek

Abstract

Robot assisted ureteroneocystostomy in a patient with a combined ureterovaginal and vesicovaginal fistula

J.-U. Stolzenburg, A. Dietel, P. Ho Thi, T. Franz, V.K.A. Arthanareeswaran
Universitätsklinikum Leipzig, Leipzig, Deutschland

Introduction: We demonstrate our robot assisted surgical technique ureter reimplantation in a 41 year old female patient who was diagnosed with a combined vesico-vaginal and uretero-vaginal fistula following a cervical myoma excision. The patient had developed a postoperative abscess which probably resulted in the fistula formation. Since conservative measures failed, the patient was posted for surgery.
Materials and methods: The bladder and vagina are mobilised and the ureter orifice along with the intramural part of the ureter is resected. It is of paramount importance to separately mobilize the bladder, and vagina for a tension free closure. An omental flap from the omentum major is mobilized. The flap is brought into the pelvis and fixed between the bladder and vagina using V-loc suture. The bladder is closed vertically and the vagina horizontally. Before complete closure of the bladder, Uretero-neo-cystostomy is performed. The ureter anastomosis is performed using 5-0 vicryl interrupted sutures in an end to end manner. A seven French double-J stent is passed over this guidewire and placed into the bladder. In this situation, in order to avoid undue pressure of the round ligament on the ureter, the round ligament is cut, and ureter along with the omental flap is lateralised. The round ligament is then re-joined using sutures.
Results: A cystogram was performed three weeks later. Since there was no leakage of contrast the catheter and double J stents were removed subsequently.
Conclusions: The video demonstrates the feasibility of robot assisted management of complex urinary fistulas. The maneuverability and flexibility of the DaVinci instruments helps the surgeon to perform these fine steps precisely.