In our environment, the most frequent cause of vesicovaginal fistula is iatrogenic. It constitutes a pathology with a high impact on the quality of life and a therapeutic challenge. The objective is to show step by step the vesicovaginal fistula correction technique after failure of previous surgical treatment, by robotic abdominal approach with omentum interposition.

We present the case of a 57-year-old woman with a history of appendectomy, right oophorectomy and salpingectomy. Later, left oophorectomy and hysterectomy, complicated with vesicovaginal fistula. Three months after treatment of the fistula by laparoscopic, the patient comes to Urology for continuous and insensitive incontinence. On physical examination, she presented negative stress test with methylene blue positive test for vesicovaginal fistula, located on the left anterior vaginal dome. CT and MRI confirm the presence of vesicovaginal fistula without other associated complications. The surgery begins with performing a cystoscopy, placement of bilateral double J and catheterization of fistula by Sensor® guide. Subsequently, the robotic abdominal approach was performed using the Da Vinci Xi®. The procedure begins with the release of adhesions from previous surgeries. Subsequently, the
vesicovaginal space is dissected to the location of the fistula, thanks to the previous catheterization of the fistula. Bladder and vaginal fibrous tissue adjacent to the fistula is resected and closed in two separate planes by continuous suture. Finally, omentuim
is inserted between the vaginal and bladder suture area to reduce the risk of recurrence.

The surgery was completed in 240 minutes. Hospital discharge was performed in 48 hours and removal of urinary catheter and catheters at 30 days after testing with methylene blue, checking correct resolution of the fistula. Postoperative cystography
was not performed due to allergy to iodinated contrasts. After three months of surgery, the patient presents resolution of the fistula, without complications.

Robot-assisted abdominal approach with omentum interposition is an effective and safe alternative for resolving complex vesicovaginal fistula.