Vesicovaginal Fistula Robotics-Assisted Repair: A Systematic Review and Quantitative Synthesis

INTRODUCTION AND HYPOTHESIS: The aim of this review is to evaluate the current literature on robotics-assisted vesicovaginal fistula (VVF) repair, with a focus on comparing outcomes of two approaches: transvesical and extravesical. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Scopus, and Web of Science were screened from inception to 13 April 2025, using variations of the search items: "vesicovaginal fistula" and "robotic surgery." Comparative studies and case series with n ≥ 5 were eligible. Outcomes were operative time (OT), estimated blood loss (EBL), postoperative complication (POC), recurrence rate, length of hospitalization (LOS), and urethral catheterization time (CT). Statistical analysis was conducted to determine overall and subgroup-specific outcomes and compare techniques for statistically significant differences. RESULTS: Fourteen studies (206 patients) met the inclusion criteria. Combined mean OT was 169.0 ± 69.5 min, with minimal blood loss across all studies (14-90 ml). Overall POC and recurrence rates were low (4.37% and 2.91% respectively), with major complications at 0.97%. No significant differences were found between surgical approaches. Most studies reported hospital stays under 5 days, although CTs varied. Two case series on recurrent VVF reported 100% success, no complications or recurrences, low blood loss, and shorter OTs, supporting the safety and efficacy of robotics-assisted repair in complex cases. CONCLUSIONS: Robotics-assisted VVF repair was found to be a safe, effective, reproducible technique, with low complication and recurrence rates, minimal blood loss, and short hospital stays. No statistically significant difference was found between techniques. The findings also support robotics-assisted surgery as an especially valuable option in recurrent cases.