This type of fistula can result in frequent urinary tract infections and the leakage of urine from the vagina can be mistaken for incontinence. All women 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, centimeter-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", stated Dr. Hemal, director of the Robotic and Minimally Invasive Urologic Surgery Programme 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 is a popular option for heart and prostate surgery and in recent years physicians have started using it for other procedures. The da Vinci surgical system has four robotic arms with centimeter-sized instruments attached. The surgeon controls these arms with hand and finger movements while viewing the surgical site on a screen. The tiny instruments - as well as 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 extreme angle.
"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", stated Dr. Hemal.
Dr. 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 the 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.
Dr. Hemal also has experience using robot-assisted surgery to repair fistulas between the bladder and uterus and between the uterus and vagina, as well as performing surgeries for urinary incontinence and prolapsed organs. The surgeries are a treatment option offered by the Wake Forest Baptist Continence Center, which is co-directed by Gopal Badlani, M.D., and John J. Smith, M.D. Dr. Hemal's colleagues on the report are Surendra Kolla, M.D., and Penkaj Wadhwa, M.D., both from the All India Institute of Medical Sciences in New Delhi.
Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital, Brenner Children's Hospital, Wake Forest University Physicians, and Wake Forest University Health Sciences, which operates the university's School of Medicine and Piedmont Triad Research Park. The system comprises 1154 acute care, rehabilitation and long-term care beds and has been ranked as one of "America's Best Hospitals" by U.S. News & World Report since 1993. Wake Forest Baptist is ranked 32nd in the United States by America's Top Doctors for the number of its doctors considered best by their peers. The institution ranks in the top third in funding by the National Institutes of Health and fourth in the Southeast in revenues from its licensed intellectual property.