case_images: PMC10834674_01
case_images: Surgical procedure of transvaginal single-port laparoscopic vesicovaginal fistula repair. (A) A single-port laparoscope was introduced into the vagina, and the vagina was expanded by insufflation with CO2 at a pressure of 6-8 mmHg. (B) A needle electrode was used to make a 0.5 cm circumferential incision to thoroughly remove scar tissue in the bladder around the fistula. (C) A ureteric catheter was passed under vision through the VVF from the bladder to the vagina. (D) Excision of 1-cm of the mucosa and muscle surrounding the vaginal scar tissue and the fistula with scissors. (E) The VVF tract was similar to a trumpet. (F) Successive single-layer closure of vesical and vaginal fistulas with 3-0 V-Loc barbed sutures under transvaginal single-port laparoscopic vision.
case_images: fsurg-11-1331476-g001.jpg
case_images: PMC10834674_01_fsurg-11-1331476-g001.jpg
case_images: F1
case_images: A single-port laparoscope was introduced into the vagina, and the vagina was expanded by insufflation with CO2 at 6-8 mmHg pressure (Figure 1A). Then, the scar tissue around the fistula was removed by making a 0.5-cm incision using a needle electrode (Figure 1B). A ureteric catheter was passed, under direct vision, from the bladder to the vagina through the VVF (Figure 1C). The single-port laparoscope was reintroduced into the vagina to allow mucosal and muscular excision of 1-cm vaginal scar tissues surrounding the fistula using scissors (Figure 1D). The fistula tract was shaped like a trumpet (Figure 1E). Finally, single-layer closure of vesical and vaginal fistulas was performed using 3-0 V-Loc barbed sutures under transvaginal single-port laparoscopic guidance (Figure 1F).
case_images: Schematic diagram of transvaginal single-port laparoscopic vesicovaginal fistula repair, which shows the innovations of this technique. (A) A 20 F Foley catheter was inserted into the bladder, 200 ml methylene blue solution was injected and immediately gushed from the apex of the vagina, thereby showing the fistula opening in the vagina. (B) A 20 F Foley catheter was inserted into the vagina, and the balloon was filled with 60 ml of saline solution. Then, 150 ml of methylene blue solution was injected into the vagina, and the cystoscope showed methylene blue gushing from the fistula opening in the bladder. (C) A needle electrode was used to make a circumferential incision to thoroughly remove scar tissue in the bladder around the fistula. (D) A ureteric catheter was passed under vision through the VVF from the bladder to the vagina. The single-port laparoscope was introduced into the vagina again. The scar tissue surrounding the fistula in the vagina was removed using scissors. (E) The fistula opening in the bladder was closed using 3-0 V-Loc barbed suture under transvaginal single-port laparoscopic vision. (F) The fistula opening in the vagina was sutured using a 3-0 V-Loc barbed suture under transvaginal single-port laparoscopic vision.
case_images: fsurg-11-1331476-g002.jpg
case_images: PMC10834674_01_fsurg-11-1331476-g002.jpg
case_images: F2
case_images: Figure 2 illustrates the schematic diagram of transvaginal single-port laparoscopic vesicovaginal fistula repair and highlights the key points of the technique.