Efficacy Analysis of Robot-assisted,Laparoscopic and Open Surgical Repair for Vesicovaginal Fistula
Wang Zeyuan
Yu Shuanbao
Zheng Haoke
Tao Jin
Fan Yafeng
Li Tengfei
Ren Xuanyi
Zhang Xuepei
Abstract：Objective To compare the therapeutic efficacy of robot-assisted,laparoscopic,and open surgical repair for vesicovaginal fistula(VVF),and to explore the related factors influencing the treatment outcome.Methods A retrospec-tive analysis was performed on the clinical data of 58 VVF patients who underwent surgical repair by a single surgeon in a sin-gle ward of the First Affiliated Hospital of Zhengzhou University from December 2015 to July 2024.Among them,10 cases were treated with robot-assisted surgery(robot-assisted group),20 cases with laparoscopic surgery(laparoscopic group),and 28 cases with open surgery(open surgery group).The surgical indicators and follow-up outcomes were compared among the three groups,and the causes of VVF repair failure were investigated.Results The median age of the patients was 50(44,53)years,and the median disease duration was 8(3,12)months.Of all patients,50 cases(86.21%,50/58)developed VVF secondary to gynecological surgery;20 cases(34.48%,20/58)had fistulas located in the trigone of the bladder;18 cases(31.03%,18/58)had a history of previous repair surgery;8 cases(13.79%,8/58)had multiple fistulas,with the median max-imum diameter of fistulas being 0.6(0.5-1.5)cm.A total of 50 cases(86.21%,50/58)achieved successful VVF repair,while 8 cases(13.79%,8/58)experienced repair failure.The open surgery group had a longer disease duration[9(8,30)months]than the robot-assisted group[5(3,12)months]and the laparoscopic group[3(3,6)months],and a higher rate of multiple previous repairs(46.43%,13/28 vs.30%,3/10 and 10%,2/20),with statistically significant differences(P<0.001,P=0.028).The open surgery group also had a longer operative time(122 min vs.87 min and 84 min)and greater intraoperative blood loss(100 ml vs.25 ml and 20 ml)compared with the robot-assisted group and laparoscopic group,with statistically sig-nificant differences(P=0.003,P<0.001).Univariate Logistic regression analysis showed that surgical approach,fistula size,number of fistulas,fistula coverage material,and disease duration had no statistically significant effects on the success of VVF repair(all P>0.05).In contrast,the etiology of VVF(P<0.001),fistula located in the trigone of the bladder(P=0.007),factors affecting wound healing(P=0.031),and postoperative complications(P<0.001)were significantly correlat-ed with the success of fistula repair.Conclusions Compared with open surgery,robot-assisted or laparoscopic surgery for VVF repair has shorter operative time,less intraoperative blood loss,and similar surgical success rate,which is a safe and ef-fective method for VVF repair.The etiology of VVF,fistula location,and factors affecting wound healing are the key factors influencing the success of VVF repair.
Keywords：vesicovaginal fistularobot-assisted surgical proceduresopen surgerytreatment outcome
Publication Date：2025-12-28
Online Publishing Date：2026-03-11(First online date of this platform, not the publication date of the document)
Pages：6( 396-401 )