This video demonstration is about Vesicovaginal Fistula Repair VVF - Lecture by Dr R K Mishra. Vesicovaginal fistulas (VVFs) are a devastating consequence of prolonged labor in developing countries and pelvic surgery in developed countries. Clinical history, physical examination, and pertinent radiographic studies are necessary for proper diagnosis. Endoscopic management can lead to successful closure of small fistulas; the advent of tissue bioglues has made this modality more promising. However, the majority of patients will require transvaginal or transabdominal repair of the fistula. This article reviews the basic principles of fistula closure and discusses adjuvant techniques with tissue interposition grafts; techniques for successful closure of fistulas; and newer modalities for repair using tissue bioglues, laparoscopy, and robotic surgery.

Vesicovaginal Fistula Repair (VVF) – Lecture by Dr. R. K. Mishra at World Laparoscopy Hospital

Vesicovaginal fistula (VVF) is a serious medical condition that significantly affects a woman’s physical health, emotional well-being, and quality of life. It is an abnormal communication between the urinary bladder and the vagina that results in continuous leakage of urine through the vaginal canal. The management of this condition requires advanced surgical expertise, careful diagnosis, and a compassionate approach to patient care. In an insightful academic lecture delivered at the World Laparoscopy Hospital, renowned minimal access surgeon Dr. R. K. Mishra explained the causes, diagnosis, and modern surgical techniques for successful Vesicovaginal Fistula repair.

During the lecture, Dr. Mishra emphasized that Vesicovaginal fistula most commonly occurs as a complication of gynecological surgery, especially hysterectomy. In developing regions, prolonged obstructed labor remains a major cause. Other contributing factors include pelvic radiation therapy, pelvic malignancy, infection, or traumatic injury during childbirth or surgery. Regardless of the cause, the condition leads to constant urinary leakage, skin irritation, infection, and profound psychological distress for patients.

Dr. Mishra explained that accurate diagnosis is the first crucial step in VVF management. Clinical examination, cystoscopy, dye tests, and imaging studies are often used to identify the location, size, and complexity of the fistula. Proper evaluation helps surgeons decide the most appropriate surgical approach. Timing of the repair is also important; in many cases, surgeons wait several weeks after the injury to allow inflammation and tissue edema to subside before performing definitive surgery.

A significant portion of the lecture focused on surgical techniques for VVF repair. Dr. Mishra discussed both traditional open surgery and minimally invasive approaches, including laparoscopic and robotic-assisted repair. He highlighted that laparoscopic VVF repair has become increasingly popular due to its advantages such as smaller incisions, reduced blood loss, faster recovery, and shorter hospital stay. The laparoscopic approach allows surgeons to clearly visualize pelvic anatomy and perform delicate suturing with precision.

Dr. Mishra also explained the key principles of successful fistula repair. These include adequate exposure of the fistula, careful dissection of surrounding tissues, excision of scarred tissue, tension-free closure of the bladder and vaginal walls in separate layers, and interposition of healthy tissue when required. Maintaining proper bladder drainage with a Foley catheter after surgery is essential to ensure proper healing.

Another important aspect highlighted in the lecture was patient counseling and postoperative care. Dr. Mishra stressed that emotional support and clear communication are essential, as many patients suffer from social isolation and embarrassment due to their condition. With proper surgical management and follow-up care, the majority of patients can achieve complete recovery and regain normal urinary function.

The lecture at the World Laparoscopy Hospital served as an important educational session for surgeons and trainees from around the world. Through his experience and expertise, Dr. R. K. Mishra demonstrated how modern minimally invasive surgical techniques can effectively treat Vesicovaginal Fistula while improving patient outcomes.

In conclusion, Vesicovaginal fistula repair is a delicate but highly rewarding surgical procedure when performed with the correct technique and understanding of pelvic anatomy. Educational lectures like this play a crucial role in advancing surgical knowledge and training the next generation of surgeons. By sharing practical insights and clinical experience, Dr. Mishra continues to contribute significantly to the field of minimally invasive surgery and the global improvement of women’s health.