Piotr Jarzemski, MD, PhD, Marcin Markuszewski, MD, PhD, Sławomir Listopadzki, MD, PhD, Marcin Jarzemski, MD, Marek Roslan, MD, PhD
Department of Urology, Jan Biziel Medical University Hospital, Bydgoszcz, Poland (Drs Jarzemski P, Listopadzki, and Jarzemski M).
Department of Urology, Medical University of Gdańsk, Gdańsk, Poland (Drs Markuszewski and Roslan).
Background and Objectives: Minimally invasive techniques have been introduced to decrease the morbidity related to standard laparoscopic procedures. One such approach is transvesical laparoendoscopic single-site surgery (T-LESS). We describe our clinical experience of using this technique for vesicorectal fistula (VRF) repair.
Description: In October 2013, we performed the T-LESS repair of a vesicorectal fistula of 5 mm diameter in a 72-year-old man, in whom conservative treatment with temporary colostomy and Foley catheter placement had failed. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device via a 15 mm incision made 20 mm above the pubic symphysis. Standard 10 mm optic and straight laparoscopic instruments were used. The fistulous tract was dissected and closed in two layers with a running, absorbable, barbed suture. A cystostomy tube was left in place for 22 days, and a Foley catheter for 1 week.
Results: The operation lasted 155 min. Blood loss was minimal. No complications were observed. The postoperative period was uneventful. During a 5-week follow-up, the patient reported no involuntary discharge of urine into the rectum. A voiding cystourethrogram revealed no presence of VRF, and laboratory examination results were all within the normal range. The colostomy was closed after 4 months, and a 12-month follow-up confirmed the integrity of both the urinary and digestive tracts.
Conclusion: Although substantial development of the instruments and skills is needed, the T-LESS VRF repair appears to be feasible and safe. Nevertheless, further experience and observations are necessary.
Key Words: Laparoscopic surgery, Prostate cancer, Vesicorectal fistula.