Vesicouterine fistulae (VUF) are the rarest type of urogenital fistulae. They are usually related to Cesarean delivery. Various open, laparoscopic, robotic and extravesical laparoendoscopic approaches were used for surgical closure of VUF [Abdel-Karim AM, et al. Laparoendoscopic single-site surgery (LESS) and conventional laparoscopic extravesical repair of vesicouterine fistula: single-center experience. Int Urol Nephrol. 2013;45:995‐1000].
Mostly, they require bivalving of the bladder. This maneuver increases the morbidity of the procedure and lengthens either the operative time or the hospital stay. For this reason either conservative treatment, fulguration of the fistulous tract or novel transvesical techniques applied for vesicovaginal fistula repair may be considered as treatment options for VUF [Tarhan F, et al. Minimal invasive treatment of vesicouterine fistula: a case report. Int Urol Nephrol. 2007;39:791‐793; Roslan M, et al. Transvesical laparoendoscopic single-site surgery to repair a vesicovaginal fistula in man after female to male sex reassignment. Cent European J Urol. 2018;71:486].
Because of the limited number of reports on this procedure in the literature, optimal treatment for VUF is an area of active investigation. In this video we present a case of using transvesical laparoendoscopic single-port surgery (T-LESS) for iatrogenic VUF repair.
To the best of our knowledge, this is the first report of application of the T-LESS approach for closure of the vesicouterine fistula.
In April 2017, we carried out the T-LESS access on a 42-year old woman, who had undergone Cesarean sections in 2010 and 2013, to close a VUF. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device (Tri-Port+) via a 1.5-cm incision made 3 cm above the pubic symphysis. Standard 10-mm optic and straight laparoscopic instruments were used. Two openings of a VUF (3 and 2 mm in diameter) were found, dissected separately, and closed in-layers with running absorbable barbed 2/0 V-Loc sutures. An 18F Foley catheter was left in place for two weeks.
The operation lasted 90 minutes. The blood loss was minimal and no complications were observed. The postoperative period was uneventful. The patient was discharged within 40 hours of surgery. During a three -year follow-up, the patient reported complete remission of symptoms. Laboratory examination results were all within the normal range.
The T-LESS procedure may be considered as a valuable option for vesicouterine fistula repair because of its minimal invasiveness, short hospital stay and fast recovery time.