Advances in Minimally Invasive Repair of Vesicovaginal Fistulas

Over the past 20 years, the discussion concerning vesicovaginal fistula (VVF) repair has evolved from strictly transabdominal/transvaginal to including minimally invasive surgeries. The original natural orifice approach through the vagina allows for VVF repair with decreased morbidity and minimal convalescence with success rates upwards of 90 %. For surgeries that involve a narrowed/stenotic vagina or a need for a concomitant abdominal procedure, transadominal surgery can be performed by laparoscopic or robot-assisted laparoscopic approaches. Success rates in large series are upwards of 86 %. Difficulties such as an increased learning curve and vesicovaginal plane dissection have been overcome with innovations such as the robotic platform and cutting to the light with vaginoscopy. While still in its infancy in VVF repair, single site surgery has also been utilized with reasonable success. Although minimally invasive surgery offers numerous advantages, the most successful approach will still be the surgery with which the VVF surgeon is most familiar.