691
995608226014562123
VIDEO4696207016978121223301405
Ces37607936014570127174
Urol39597936014578115180208
2019;41927936014562121176229253
23(2):44707936014562122153211241263
97–10047597936014561119173226281344
KLÍČOVÁ625884014770132164236320392464
SLOVA1116884014762123207279351
Vezikovaginální6241048013156105150173218274323373432454511560582640661
píštěl,1306104801316183125160210233250
laparoskopie,1580104801312069128178209266306351408468491543560
robotická2164104801312985146205237259308353404
chi‑25891048013149106128161
rurgie,624119801313291122180202254271
jednoportový919119801312476136194252313372404441497545597
přístup.1540119801316193115154189246306324
SUMMARY6251484014762143243345423493561
Schraml7741648013151100158189239328351
J,1149164801314663
Hlavička1244164801316991140188211259304355
M,16311648013186105
Broul1760164801316496152210232
M,20251648013185105
Cihlář2154164801317193150173221253
F.2431164801315866
Mini‑25291648013186108166188221
mally6241798013193144167190240
invasive889179801313393142194235258309363
closure1277179801315983143185244277330
of1633179801316898
a17571798013160
vesicovaginal18421798013160114156178229287337389451474534585608
fistula2476179801313663104140200223274
using624194801315898119177236
robotic884194801313389149208241263311
single‑site1219194801314163120180202254289329351384435
surgery.1678194801314198129187240271323336
We7742098013190140
report938209801313889149208240277
our12442098013159117148
experience14162098013158106166220252274327385433484
with19292098013180102135194
the2147209801313997150
closure2321209801315476134174230262313
of2663209801315987
a6242248013151
vesicovaginal7012248013159113155177227285335387449472531582605
fistula1332224801313663103139199223273
using16302248013169110132192253
a19092248013159
highly1994224801316992153213236286
minimally23142248013192115175198289340363386436
invasive624239801312380127177216237287338
technique986239801313081130188245267325382435
–14412398013155
using1516239801315897119176235
a17712398013150
single‑port1841239801314162120179201253288348407439476
approach23372398013150109169201257307355413
with6242548013179102135193
the841254801313492146
da10112548013159108
Vinci1143254801315680138187208
Xi1375254801316082
robotic1481254801313389149209241263311
system:1816254801314191131166217306323
a21632548013150
video.2237254801315073132185244261
Introduction:774269601332787121156215278337386424448507568589
Vesicovaginal13852698013164113153173221277324374433454511560581
fistulas199026980131346199133190212260299
(VVPs)2313269801313695155211250274
are2610269801315888139
amongmuch‑feared6242848013149136192248306412467513569601628678724753803861
gynaecological15022848013159106163209260308361383439497517563611631
complications.21502848013149103190247269288335382413433488545582600
A6242998013164
VVP7092998013156116170
in902299801312177
itself100229980131215394146167194
is1219299801312159
not12982998013159116148
life‑threatening146929980131214168119153185242272322369400450507528584642
for2134299801312783114
the2271299801313188140
patient,24322998013161109140161213270300318
but6243148013161118150
the797314801313592144
resulting964314801313383123178199231252308367
urinary1355314801315888110166214244295
incontinence1672314801312481128183240271292349401457505555
significantly2250314801314162120176197222248296344401432453500
impairs6243298013123111169218239269308
her9553298013159111141
quality11193298013160116164185205237288
of1429329801315986
life.153832980131234471122138
The16993298013151110162
extent18833298013154100136186242273
and21793298013150107165
nature23673298013159106137194224275
of2664329801315986
urine624344801315889110167219
leakage866344801312273120165214273325
depend12123448013160112171224280339
on15733448013158116
the1712344801313289141
size1876344801314060103154
of2052344801315885
the2160344801313390142
VVP.23243448013156116171175
A7743598013164
VVP8653598013156117173
closure1062359801315173131171228259311
can13973598013151101159
be15823598013161115
performed17233598013161115147179236268358411471
via2218359801315275123
both23683598013161120152210
the2602359801313795148
vaginal6243748013150100159181238287309
and9573748013153111170
abdominal11513748013152112172231320342399448470
routes.1646374801313491149182233274293
In1963374801312684
the2071374801313694147
era2245374801315384134
of2406374801315887
open25193748013159119173231
surgery,6243898013142101134194249282335349
the9993898013143104159
vaginal11833898013160112173196256307330
approach15393898013160121184217276328379439
was20123898013181133174
used22123898013168109165227
as24643898013160102
the25913898013144104159
first62440480131275384125160
step808404801314882133193
due10254048013167124176
to1226404801314096
its1346404801313064105
minimal14824048013190112170191280329351
invasiveness,1857404801313088135185224246295347405458498538556
and24374048013157115174
an26354048013157115
invasive624419801312379125174212233281331
abdominal9744198013150108167224312333389436458
approach14514198013149107166197252301349405
with18754198013178100132189
laparotomy2087419801311967125174204259291345433478
was25844198013179127166
only6244348013157114135181
adopted8244348013149106163221252301360
after1202434801314976112161191
a14124348013149
failure148443480131247293114169199249
of1751434801315885
the1859434801312985136
vaginal2014434801314896154175230277298
approach.23314348013149106165195250298345401419
The7744498013151111164
introduction962449801313088120151208268325374410432490548
of1535449801316594
laparoscopy1653449801313079138188220276316365421481528
reduced2205449801314091152209257308368
the2598449801314199152
invasiveness624464801312379126175214235283334391443483522
of1165464801315886
the1275464801312986139
transabdominal1437464801313061110167206255314373430519540597645666
approach,21234648013149108167198254303351408425
and,25684648013149106165182
due6244798013161119174
to8234798013143100
a9484798013159
higher1032479801316991152211266298
effectiveness1355479801316393123176227265288338391451505547588
of1968479801316897
this20904798013143103125165
procedure22804798013170103161212265326385417470
in624494801312382
comparison7314948013158115206267318350373413472532
with12964948013181104138197
the15184948013143102156
vaginal16994948013159109170193251301324
approach,20484948013159119181214271322372431449
lapa‑2522494801313282142193228
roscopy624509801313390130179236296344
has9925098013168117157
become11745098013169123173230320374
the15725098013142101154
method17595098013190144177236295356
of2139509801316796
first225950980131356293134169
choice24535098013157115174197245297
in624524801312381
most7365248013190148188223
centres.9835248013156107165197228280320340
The13475248013158118171
subsequent15425248013148105164204257318375428486517
introduction2083524801313188120152208269326374410432490549
of2656524801316594
robot‑assisted624539801313391153214247277327368409431471507559621
surgery12705398013150108141200254287340
has16355398013169119160
helped18205398013168123146207262324
to21695398013143101
overcome22955398013168117171203251309400455
some624554801314198187240
of884554801315886
the994554801313087140
obstacles11545548013158118157191241289311363403
of1577554801315886
classic1683554801314870118158197218266
laparoscopy,1972554801312068127176207263303351406466513526
while25185548013179137158180232
maintaining6245698013189136157213244292313369389446503
all114656980131497191
the1260569801313086138
advantages14175698013149107155203259290338396448487
of1922569801315885
minimal20265698013189110166186273321342
invasive‑2391569801311874120169207227275326359
ness6245848013159112152192
(it84058480131264780
is945584801311958
a10235848013150
higher‑grade1094584801315980139197250282310372404453513566
laparoscopy).1684584801312068128178209265305354410470517544559
This22645848013151111132171
is2459584801312059
even25385848013153102154212
more6245998013190148180232
enhanced8805998013159116174223281329380441
when13505998013179138191249
the1623599801313997150
single‑port1797599801314668125185207260294355414446483
technique2304599801313990140198255277336393446
of624614801315987
the735614801313492145
da9046148013160109
Vinci1037614801315680138186208
Xi1269614801316082
Single‑Site1375614801315172129189211264298345367400451
technology1850614801313485134192250308331389449498
is2372614801312362
used.2458614801315998151211230
Indications774629601332686146170218270304328387447488
for1284629601333796131
and14376296013358117178
the16376296013341100154
operating18186296013361122177211263297321380440
procedure2285629601336398156205257319377411465
of624644601336091
a7376446013358
single‑port817644601334973132192216270305368428462500
robot‑assisted13396446013341100161221256285336378419443484520573634
closure1995644601335579138179238272325
of2347644601336191
a24606446013358
vesicovaginal254164460133581101521766246596013349107157209269293352403427
fistula:107965960133295899135194218269290
We13976598013190139
report1559659801313889147206236272
a18546598013156
50-year‑old19336598013160110145192243290320348407429487
patient24496598013161110141162213270301
who6246748013179137194
underwent8466748013159115174226256337388445475
laparoscopy‑assisted1344674801312977135184214269308356411470516548595634673693731764814873
vaginal22406748013155104162183240287308
hys‑25776748013159104143173
terectomy624689801313484114165213248303391437
with10806898013180101133190
right1293689801313051109166196
adnexectomy.15096898013150109165217264314362397452541586598
The21276898013151110162
procedure2309689801316192147195245304360390441
was6247048013180129168
carried8157048013156106136168189241301
out11397048013166123156
under13187048013166123182234265
general16067048013167120177229260309330
anaesthesia19607048013157114162214254288345398437458505
in2488704801313087
the2599704801314198151
Trendelenburg624719801315175125182240292314365422481538568625
position12707198013161119158178210231288345
of1637719801315886
31°.1744719801315499125137
We19037198013190139
use2064719801315896148
this2235719801313390110148
position24057198013160118157178210231287345
by6247348013161108
default7557348013167120147197253275307
in1086734801313087
this1196734801314199120158
type1377734801314192152206
of1606734801316694
surgery.17237348013148104135192245275326339
The20867348013158117170
abdominal22797348013158117176234323344401450471
cavity624749801314895140161192240
was8817498013178125162
openedwith10597498013158115166221272329423444475530
a16057498013149
25-mm16717498013153103133220305
semi‑lunar1993749801314090176196226248302357403432
incision2447749801311771117137173193247303
at624764801315081
the728764801313491143
umbilical8957648013158146204226247267314363384
margin13027648013191138168225246302
and16287648013150106165
by18167648013161107
carefully1946764801315098128179206263284305352
dissecting2321764801316081119158209258293314370429
the297689801313593146
individual314689801313189149170220242302359408430
layers.360089801313180127179210251270
Once3901898013176135184235
the4160898013142100153
abdominal4337898013158119179238328350408457479
cavity4840898013157107155177211262
was29761048013179127165
inspected3163104801311873111168220268302352410
with35901048013179100132188
no37951048013159115
pathology39271048013161109139195252273329388434
found,4384104801312378134190248264
the4671104801312885136
single‑site482410480131416111617419424542949656314294965642429496563642949656574294965694
working32211048013180124148191210266321
disk3559104801316079116159
was37361048013180127165
deployed39201048013160111169190247292343402
into4344104801312076107161
the4528104801313187139
abdomen46871048013150108167224312364421
through2976134801313490120175232290346
the3344134801312986138
incision3504134801311874122142180200256313
in3839134801311975
its393613480131185091
folded4049134801312480102159211269
configuration,43361348013149104161185211269325355403434455511568584
and49381348013150106164
then2976149801313491143200
unfolded31981498013158115141197219277329388
and36081498013150107165
self‑secured3796149801314092114141170209261310366396446506
in4325149801312278
the4426149801313390142
wound.45901498013179135192249307325
Using31261648013169107128186245
this33951648013142100122161
disk,3580164801316789128173194
an37981648013157115
optical39371648013166127159181230279302
port42631648013168127159196
for4483164801313794126
a46331648013157
standard4714164801314983133191250299330388
8-mm2976179801315488178267
robotic3267179801312986146205238260308
3D35961798013154123
camera3740179801314998187241272322
with40831798013179102135193
oblique42971798013159119142164222280332
optics46501798013159119152174222264
and49351798013150108167
two29761948013134114170
curved31661948013148104135187238297
5-mmworking3482194801315385174262360416447492516572630
ports41321948013160118149185226
for4381194801312581112
flexible4513194801312652104151172231253305
robot‑4841194801312884143201233261
ic2976209801312371
instruments3071209801311977116151182240329382440472513
were36042098013180132163214
placed3839209801316083132180231291
through4154209801313189120176234293351
prefabricated4525209801316193144172222282314336385434466517577
openings.29762248013159119173231252310369408428
There34262248013151111164196247
is3697224801312261
one37802248013158117170
more39722248013190149181232
site422822480131406194145
in4397224801312279
the4500224801313291144
disk4666224801316082121166
for4856224801312784116
an49942248013150108
8-mm2976239801315386175263
or3259239801315889
10-mm3368239801315399134223311
assistant3699239801314988127148186220269326357
port;40752398013160119150186205
we42992398013179130
used4449239801315896149208
the4680239801313087139
8-mm4839239801315386175263
one,29762548013159117170187
and31872548013150108167
completed33782548013149105195254277330363414475
robot3877254801313289149208240
docking.41422548013159118167212236294353372
The31262698013151111164
fistula331626980131265392126184206255
location3595269801312583132182214236294352
and39712698013152110169
its416426980131245899
relation4288269801313385108156188210268327
to4639269801313591
the4754269801313694147
ure‑4926269801315990142176
teric2976284801313383113135182
orifices3177284801315788110135161208257296
were34922848013178129159209
identified3725284801311876127183214235260286338396
transvesically.4144284801313060109165203252303341362409457478499546558
Next,47212848013169121167203221
the4965284801312985137
fistula297629980131265391125182204252
canal3248299801314998155203225
was34932998013179128167
resected3684299801312879119171220256306366
and40702998013149107165
the4259299801313087140
vaginal4419299801314998157179235284305
wall47442998013179128150171
was49352998013179128168
dissected2976314801315980117156207255290339398
from3397314801312456111198
the3618314801312985137
bladder3774314801315981129186244295325
which41183148013178135156202259
was43953148013178126165
mobilized45793148013188145203225246266308358417
as5015314801314987
far2976329801312878108
as3103329801314988
possible32103298013160117156195215273295347
from3580329801312456111199
the3802329801313086138
vaginal3959329801314997155176232280301
wall42793298013179127148169
with44673298013178100132189
the4679329801312986138
fistula.483632980131265290123180201248266
Closure2976344801316385143183239270322
of3318344801315987
the3429344801313189142
vagina35913448013150100159181238287
and38993448013150107167
bladder4086344801316184133192251304336
was44423448013180129169
performed46313448013161115146178236268358411471
with29763598013178100133189
non‑absorbable31853598013158115172205252311350406438497545604626678
V‑LOC3882359801315585134202264
90R416535980131531074272360407632
sutures4327359801313691124180211261300
and46473598013149105164
Strata‑4830359801315080111160191240272
fixTM2976374801312753100144228
sutures32283748013146102136193225276317
on35733748013158117
an37143748013154112
indwelling3850374801312785144223275298319341399458
Foley43323748013155112135188235
catheter45913748013154103136194247280331362
Ch49823748013162120
2029763898013154107
that31073898013143102151184
was33243898013180130171
kept35193898013156108169202
in3746389801313190
situ3860389801315072105164
for4049389801313795128
2142013898013163111
days.43363898013169118165207227
At45873898013174105
our47173898013167126158
cen‑49003898013157109168202
tre,2976404801313466117134
removing3134404801314091180238287310367427
an35854048013157114
indwelling3723404801313088147226278301323344402461
urinary4208404801316697119177226257309
catheter45414048013156106138196249282333365
in4930404801313087
350414048013161
weeks’29764198013179132185231275293
time3293419801313053141194
is3511419801312059
a35904198013150
standard3661419801314175125183242291322380
procedure.4061419801316193150199250310367399450467
According45494198013164112158214246304326383442
to5016419801313086
the2976434801313492145
literature314543480131204174125157206239296327379
(1,354843480131257384
2,3653434801315371
4,3744434801315471
5),383543480131548196
a39524348013150
catheter4022434801314999131189242275326357
can4400434801314998156
be45764348013161115
removed4715434801312980169227276327388
earlier29764498013153101133156177230261
than3261449801314098147205
that3490449801314098147179
(in3693449801313657115
738324498013160
to3916449801314096
1040364498013160107
days).41684498013166114161201226241
The44334498013158118171
abdominal46284498013156116176234324345403452474
drain2976464801316091141163220
was32204648013180130169
removed3413464801313384173232280332392
on38294648013159117
postoperative39704648013161120160195251311365396446479501550602
day45964648013160108155
2.4775464801315471
The31264798013151111164
total3314479801313490123172195
duration35334798013160117148198230252310369
of3926479801315887
surgery4037479801314198129187240271323
(skin4384479801312967112136194
to4602479801313490
skin)4716479801314186110168193
was49334798013180129169
1352976494801315498148
minutes,31484948013190112170227260311351370
with35424948013180102136194
the3760494801313492145
robotic3929494801313389150209241263312
console42654948013149105163203261284337
time4626494801313456145198
being48484948013161115137195254
6529765098013154105
minutes.31055098013190112169226260311351371
Result:31265246013359113155213238273295
The34415248013151110162
postoperative36225248013160118158191247306359390439470492540591
course42325248013149104161191232284
was45355248013179128166
unevent‑47215248013158115167215265322354382
ful.2976539801312986108126
On31215398013173131
day32715398013159107153
2134435398013153100
after3562539801314976113163194
surgery,3775539801314196127184236266317330
the4128539801313087139
indwelling4290539801311976134211263284306326383441
catheter4751539801314897128185238270320351
was29765548013178127166
removed,3165554801312878166223270321380397
and35825548013149106164
since3765554801314161117165215
then,4003554801313086138195212
the4239554801312986138
patient43965548013160109140162213270301
has47165548013158106145
been48805548013160113165222
completely29765698013149105195254277330363414437485
free3485569801313467118172
from3681569801313467123213
urological3918569801316495152175233293315363413435
complaints,43775698013154110200259282331353410442484502
with49095698013179102135193
the2976584801313390142
umbilical31375848013158145203224246266313362383
scar3539584801314088136167
being37255848013160112133189247
firm399158480131275383171
and41815848013149106164
healed43645848013158110156178229288
to4675584801313084
such4778584801314196143200
an49975848013149105
extent29765998013153101138189246278
that3278599801313492141173
it3475599801312357
is3556599801312362
unnoticeable36425998013158116174232264286335386434493516569
at4235599801315082
first434159980131275485126160
glance.4525599801316082131189237288305
Discussion:3126614601337398140188247289330354413473494
When36506148013190149201258
the3931614801314198151
abdominal41056148013157115175232321342399446468
approach45966148013157115175206262311358415
is5034614801313068
indicated2976629801312380139160208257289339399
in3399629801313087
the3509629801314299152
management36916298013191139197245304356445498555587
of4301629801316694
VVF,44186298013164124175181
we46296298013180132
recom‑4785629801313990139195284317
mend29766448013189140195252
considering32456448013148102158195214271321351371426483
the3750644801312984135
use3902644801315794145
of4064644801315884
robotic4170644801312781139195226246292
or4479644801315787
laparoscopic4588644801311864121169198252290336390448468514
approach29766598013150108168198254303350407
in3406659801312278
order3506659801315889146198228
to3757659801313388
minimize38666598013190111168188276297339390
the4279659801313289141
morbidity44426598013190147178237259317338370420
asso‑4884659801315088127184218
ciated2976674801314970117148198257
with32586748013179101133190
major34736748013190138159216247
incisions.3743674801312481128149187207264321359378
The41466748013151110162
first433367480131265383123156
case45126748013151100138190
of4727674801315986
robot‑assisted4836674801313590149207239429496561942949656394294965646429496566642949656744294965706429496573142949657764294965828
repair3385674801312674130176194223
of3625674801315884
VVF37266748013156114163
was39066748013179127164
reported4093674801312777135192222258307366
by44766748013161106
Melamud46006748013185137158205292347405
et5023674801315385
al2976704801315071
in3070704801312278
200531707048013154104158209
(1).340270480131287493107
Since3531704801315171127175225
then,3779704801313289141198215
a40167048013150
number40887048013158114202261314344
of4454704801315886
small45637048013139127175196216
studies4802704801314074130189209261300
and29767198013150107165
case3163719801314998136188
reports3374719801313182140199229265306
have37027198013159106153204
been39287198013160113166223
published41737198013160117176198218256312364424
(2,462071980131287894
3,4736719801315470
4,4827719801315470
5,4919719801315468
6).500971980131547993
Although3126734801316487120178236294354411
no35617348013159117
direct3702734801316082113164214250
comparisons39767348013149105194254304335358397455514553
of4553734801315887
VVF46637348013156117169
repair4856734801313283143193215246
using2976749801315898119177236
robot‑assisted3236749801313389150209241270319358398420459493544604
vs.3865749801314990109
open39997498013158119173231
vs.4254749801315090110
laparoscopic4388749801312372132181213269309358414474497545
ap‑49577498013150110145
proach2976764801316092148198246304
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available,3452764801315097146168190238297320372389
the3865764801313088140
benefits40257648013161115172225250277310351
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