A novel endoscopic surgery method: transurethral surgery – natural orifice translumenal endoscopic surgery (TUS-NOTES) for treatment of vesicovaginal fistula at 37 patients

Background 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 hereby present a new minimally invasive surgery technique to perfom a fistulae repair of inside closing without transcutaneous, laparoscopic or vaginal incision: transurethral surgery- natural orifice translumenal endoscopic surgery (TUS-NOTES) by using a new small fine needle holder and knot pusher.

Methods Setting: A rigid cystoscope with 30 degree optics is inserted into the patients bladder with CO(2) insufflation. After inspecting the bladder and finding the fistulae orifices the fistulae area is manipulated with an endoscopic hooklet. The bladder segment is excised with electrocautery. Single button sutures are placed and closed by means of an extracorporal knot. This procedure is repeated till the whole is closed.

Results The aim of the poster is to present the TUS-NOTES technique and teach the viewer how to apply this novel intervention to close the fistulae inside of bladder at 37 cases. The mean operative time was 55 min (35min–110min), whereas the blood loss was less 10ml. The patients were discharged 3 days after surgery, and the catheter were removed 10 days after surgery.

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

Publikationsverlauf

Artikel online veröffentlicht:
11. Oktober 2022