# Robot-Assisted Uterus-Sparing Repair of a Vesicouterine Fistula 26 Years After Cesarean Section: A Case Report and Review of Surgical Techniques

## TL;DR

A robot-assisted surgery successfully repaired a rare bladder-uterus connection 26 years after a cesarean section, preserving the uterus.

## Contribution

Demonstrates a novel robot-assisted, uterus-sparing technique for repairing vesicouterine fistulas.

## Key findings

- Robot-assisted repair preserved the uterus and achieved successful fistula closure.
- Postoperative cystography confirmed no recurrence or defects.
- The patient remained asymptomatic after the procedure.

## Abstract

This video illustrates the surgical repair of a vesicouterine fistula (VUF) via a transperitoneal, robot-assisted, uterus-sparing approach.

In this video, we present a VUF that occurred after a cesarean section. The patient presented 22 years later with persistent hematuria. She underwent a uterus-sparing, robot-assisted repair via excision of the fistula tract. The uterus and bladder were closed in multiple layers with omental interposition.

The patient tolerated the procedure well. A follow-up cystography confirmed the absence of defects or fistula recurrence. She has remained asymptomatic since the surgery.

Our video demonstrates the feasibility of vesicouterine fistula repair with uterine preservation using an exclusively robot-assisted transperitoneal approach with omental interposition, yielding excellent results.

The online version contains supplementary material available at 10.1007/s00192-025-06304-w.