Urinary abnormality successfully treated with robot-assisted surgery
8 September 2008
Robot-assisted laparoscopic surgery has been successfully used to
repair abnormal openings between the bladder and vagina known as
fistulas, it is reported in the online version of the Journal of
The procedure was carried out by Dr Ashok Hemal, a urologic surgeon
at Wake Forest University Baptist Medical Center, and colleagues. This
type of fistula can result in frequent urinary tract infections and the
leakage of urine from the vagina and can be mistaken for continence.
All the women patients in the study had previously undergone
unsuccessful surgeries to repair the problem. In most cases, the
patients in the report would undergo abdominal surgery, requiring a
large incision. Instead, centimetre-sized instruments and a small camera
were inserted through five small incisions in the abdomen.
“There was less blood loss with this procedure than with conventional
surgery and there is the potential for a faster recovery,” said Dr Hemal,
director of the Robotic and Minimally Invasive Urologic Surgery Program
at Wake Forest Baptist. “The results were outstanding and suggest the
robot-assisted surgery is an attractive option for fistulas that would
normally require abdominal surgery.”
Robot-assisted surgery has been increasingly used for heart and
prostate surgery in recent years and physicians have started using it
for other procedures. The da Vinci surgical system has four robotic arms
with centimetre-sized instruments attached. The surgeon controls these
arms with hand and finger movements while viewing the surgical site on a
screen. The tiny instruments and the ability to see the surgical site at
tenfold magnification allow for very precise, refined movements.
The type of fistula that the surgeons repaired can occur one to six
weeks after gynaecologic or obstetric surgery, such as a hysterectomy.
The women in the report had fistulas located in the supratrigonal
region, which is at the lower portion of the bladder near the tubes that
carry urine from the body.
Fistulas in other areas can often be repaired with a vaginal approach
or with laparoscopic surgery, which uses a camera and small incisions —
but is not robot-assisted. However, these approaches are not generally
used in the supratrigonal region because the physician must work at an
“Robot-assisted surgery has promise to bridge the limitations of
laparoscopic surgery and allow more women with fistulas, urinary
incontinence or prolapsed pelvic organs to benefit from a minimally
invasive approach,” said Hemal.
Hemal had previously published a report in Urology (May, 2006) using
robotic-assisted surgery to repair first-time fistulae in women. All the
patients in current report had undergone previous failed surgeries —
five of the women had at least two failed prior surgeries. With the
robot-assisted approach, mean operating time was 141 minutes and mean
hospital stay was three days.