Robotic repair of rectovesical fistula to open radical prostatectomy

abstract

Introduction and Objective: Rectovesical fistula is a rare entity that can develop after trauma, radiation, congenital diseases, inflammatory bowel disease, and open radical prostatectomy. Herein we present our experience with robotic assisted fistula repair. Methods: Three patients were treated. Th...

e etiology of rectovesical fistula developed was open radical prostatectomy in all patients. The robotic procedure was preoperative following failed open repair in two patients, and primary in the third. All patients had previously undergone fecal diversion. The operative steps were as follows: (1) cystoscopy, (2) RVF catheterization (3) five-port transperitoneal laparoscopic mobilization of omental pedicle flap, (4) cystotomy extending towards to the fistula tract, (5) robot docking (6) dissection of the rectovesical plane, (7) interrupted rectal closure, (8) omental interposition, (9) bladder closure, (10) suprapubic tube placement (11) drain placement. Results: Mean operative time was 153 minutes (range 120-180). No intraoperative or postoperative complications occurred. All patients remain free of fistula recurrence by cystographic studies at mean followup of ranging from 2 weeks to 10 months. Bowel continuity has been restored in 2 patients and is planned in 1. Conclusions: While we await longer followup and experience in larger series, robotic repair of rectovesical fistula appears feasible and represents an attractive alternative to open or laparoscopic approaches.

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