Robot-assisted repair of complex vesicovaginal fistula after multiple prior surgeries: first reported case in Peru

Introduction: Vesicovaginal fistula is a complex urological complication that significantly affects patients’ quality of life. In recent years, robotic surgery has emerged as a minimally invasive alternative for its repair, offering advantages such as enhanced three-dimensional visualization, greater surgical precision, and improved intracorporeal suturing. Clinical case: We report the first case in Peru of robotic repair of a complex vesicovaginal fistula. The patient was a 51-year-old woman with a 3 × 2 cm retrotrigonal vesicovaginal fistula caused by hysterectomy performed for fetal death, with a history of multiple previous abdominal surgeries, including cesarean sections and open cystolithotomy. The diagnosis was established by cystoscopy, cystography, and the methylene blue test. Robotic transperitoneal repair was performed with multilayer closure using V-Lock sutures and ureteral stenting. Conclusions: Robotic repair represents a feasible and effective alternative for the treatment of complex vesicovaginal fistulas, allowing precise dissection and favorable clinical outcomes.