Robotic pneumovesical vesicovaginal fistula repair using the da vinci sp system: technical feasibility and early outcomes.

OBJECTIVE: To evaluate the outcomes and technical feasibility of robotic-assisted pneumovesical repair of vesicovaginal fistulas (VVFs) using the da Vinci single-port (SP) robotic system. METHODS: Between April 2024 and January 2026, ten patients underwent robotic-assisted pneumovesical VVF repair. Following diagnostic cystoscopy, a single 2.5-3 cm suprapubic incision was created, and a robotic port was placed directly into the bladder. A pneumovesicum was established using CO₂ insufflation, and the fistula tract was dissected and closed in layers using the da Vinci SP system. RESULTS: The mean patient age was 45.9 years, and the mean interval from injury to repair was 7.4 months. Six patients had recurrent fistulas, including four who had previously undergone extraperitoneal repairs (two laparoscopic, one da Vinci Xi, and one da Vinci SP). One patient had prior transvaginal repair, and another had undergone robotic pneumovesical repair at another institution followed by transvaginal repair. All fistulas were single and predominantly supratrigonal (9/10), with one infratrigonal case, and measured 3-30 mm. One patient developed recurrence after primary repair and was successfully treated with repeat robotic pneumovesical surgery. The mean operative time was 106 min, with a mean robotic console time of 50.4 min. The median follow-up period was 9 months. No blood transfusions, conversions to open surgery, or postoperative complications occurred. Surgical success was achieved in 9 of 10 primary repairs, and the single secondary repair was also successful. CONCLUSIONS: Robotic pneumovesical VVF repair using the da Vinci SP system was technically feasible and showed promising early outcomes. The SP platform enables direct intravesical access and precise suturing within a confined workspace, representing a potential minimally invasive option for selected VVF cases.