Natural Orifice Transluminal Endoscopy-Assisted Extraperitoneal-Intravesical Surgery with Laparoscopic Instruments: (1) Repair of a Supratrigonal Vesicovaginal Fistula (2) Removal of Multiple Bladder Stones

Tsun-Hsiang C1, Wei-Yu L2

Research Type

Clinical

Abstract Category

Female Stress Urinary Incontinence (SUI)

Abstract 840
Non Discussion Video
Scientific Non Discussion Video Session 200
Incontinence Female Surgery Fistulas
1. Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan, 2. Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Links

Abstract

Introduction 
Nature Orifice Transluminal Endoscopy-Assisted Extraperitoneal-Intravesical (NOTE-EI) surgery, utilizing laparoscopic instruments, presents a viable option for treating supratrigonal vesicovaginal fistula (SVVF) in women or managing multiple bladder stones in men. Herein, we present the procedural setup and outcomes from four consecutive operations.
Design 
Initially, bilateral ureter catheters were inserted, alongside SVVF via transurethral cystoscopy. Subsequently, a 10mm balloon trocar was placed in the vagina to prevent air leakage through SVVF during pneumo-bladder insufflation, while also serving as an additional perioperative working port. The patient was positioned in a sharp Trendelenburg posture, with the surgeon positioned between the split legs. Two 5mm ports, spaced 2cm apart from the midline, were inserted near the suprapubic bone using an extraperitoneal approach. To minimize surgeon discomfort, cystoscopy transitioned to ENT sinuscopy for brief periods. Dissection of the vagina and detrusor was performed using hook and forceps. Optimal angles for delicate suturing were achieved by alternating between suprapubic and urethral trocars. A leak test was conducted using 150ml beta-iodine mixed with normal saline, with cystostomy maintained via the suprapubic trocar until cystography confirmed SVVF resolution.
A similar setup was utilized for men with multiple bladder stones, with the distinction of perioperative infusion of normal saline instead of pneumo-bladder. A Fr 28 Amplar sheath, commonly employed in nephrolithotripsy, facilitated the rapid removal of 24 oval-shaped bladder stones under transurethral cystoscopic illumination in less than an hour.
Results 
All patients attained either complete continence or stone-free following NOTES-EI surgery conducted with laparoscopic instruments.
Conclusion 
NOTE-EI surgery with laparoscopic instruments offers a minimally invasive approach suitable for repairing SVVF or managing multiple bladder stones effectively.
References 
  1. Tavares MA, Campagne Lpiseau S, Canis M, Botchorishvili R. Intravesical repair of vesicovaginal fistula guided by cystoscopy. Facts Views Vis Obgyn. 2021 Jun;13(2):175-178. doi: 10.52054/FVVO.13.2.022. PMID: 34184847; PMCID: PMC8291990.
  2. Baron TH. Natural orifice transluminal endoscopic surgery. Br J Surg. 2007 Jan;94(1):1-2. doi: 10.1002/bjs.5681. PMID: 17205508.
Disclosures
Funding no funding source to declare Clinical Trial No Subjects Human Ethics Committee Chang Gung Medical Foundation Institutional Review Board Helsinki Yes Informed Consent Yes
16/07/2025 03:54:34