Robot-assisted management of urological injuries following gynecological surgeries: Our Experience

Background and objectives: Robot-assisted minimally invasive surgeries have rapidly increased during the last decade. The objectives of the present study were to report our initial experience on robot-assisted management of urological injuries following gynecological surgeries, i.e., vesicovaginal fistula (VVF) repair and ureteric reimplantation for ureterovaginal fistula (UVF) and posthysterectomy ureteric strictures, using the da Vinci robotic system. Materials and methods: We performed robot-assisted surgeries in 12 such cases from February 2016 to September 2018. These include 7 cases of VVF repair, 2 cases of ureterovaginal fistulas and 3 cases of post-hysterectomy ureteric strictures requiring re-implantation. Results: All 7 patients who underwent VVF repair had no requirement of analgesics from 3rd day onwards and early convalescence, with only 1 having delayed recovery, The patients who underwent ureteric reimplantation for ureterovaginal fistula and ureteric strictures recovered well, with no hydroureteronephrosis or reflux of urine in any of the patients during follow-up. Conclusion: Our study concludes that, robot-assisted VVF repair and ureteric reimplantation for ureterovaginal fistula and ureteric stricture are safe and feasible and provides all the advantages of minimally invasive surgery, with additional benefit of enhanced precision, range of motion, visualization and access to pelvis and patient-related benefits of less pain, faster recovery, shorter hospital stay and early return to normal activity.