Presented by: Joerg Neymeyer Dr.
Medical University Charite - Berlin - Department of Urology

Introduction

Vesicovaginal fistula (VVF) formation represents a condition with devastating consequences for the patient and continues to pose a significant challenge to the surgeon. To minimize the morbidity of classical fistula repair, we present a minimally invasive surgery technique in transurethral surgery- natural orifice translumenal endoscopic surgery (TUS-NOTES) by using a new small fine needle holder and knot pusher.

Materials

A rigid cystoscope with 30 degree optics is inserted into the patients bladder with CO(2) insufflation. The fistulae orifices is excised with electrocautery. First the monocryl 3-0 fibre is put into the needle holder. To fit into the needle is bended. The needle is put loose next to the cystoskope put into the bladder and after touching the wall the fibre is fixed at the end of the needle holder with a clamp. Now by a rotation the whole is at both sides stiched. With a grasp –put through the working channel- the needle is grasped and by loosing the clamp everything can be pulled out. By tying an extracorporal knot and putting an knot pusher over the fibre, the knot is fixed. This procedure is repeated till the whole is closed. The fibres are cutted.

Results

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29 cases were treated. The mean operative time was 45 min (25min-110min), whereas the blood loss was less 10ml. Discharged at 3rd day.

Conclusion

To reduce morbidity and prolonged recovery of excision of the VVF - TUS-NOTES technique is efficacious and the preferred method of intervention.

Funding

none

Lead Authors

Alkan Cubuk, MD
Kocaeli University Hospital - Department of Urology

Sarah Weinberger, Dr.
Medical University Charite - Berlin - Department of Urology

Viktoria Schaeff, Dr.
Medical University Charite - Berlin - Department of Urology

Katharina Mala, Dr.
Medical University Charite - Berlin - Department of Urology

Thorsten Schlomm, Prof.
Medical University Charite - Berlin - Department of Urology