Robotic-Assisted Transabdominal Repair of Vaginal Dehiscence Following Robotic-Assisted Radical Cystectomy: Twelve Month Outcomes

Vaginal complications are diagnosed in around 20% of women following radical cystectomy. Vaginal dehiscence is the most frequently observed of the three types of complications seen, which also include vaginal prolapse and fistula. A dehiscence occurs when the vaginal closure fails and a hernia is formed. It can present early, within 3 months of surgery, but has also been described as presenting over 12 months after cystectomy. The hernia sack is lined with peritoneum and may be empty or contain pelvic contents. Symptoms include vaginal discharge, vaginal bulge, or a more acute presentation with evisceration of the pelvic contents and bowel obstruction. Surgical repair of dehiscence is therefore recommended, but the optimum technique is not known. Open, robotic, and vaginal techniques have been described using primary closure, myo-cutaneous flaps, and synthetic meshes. Here, we present a robotic-assisted transabdominal approach utilizing a biological mesh. To our knowledge, this is the first description of this technique.